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: POR OFFICE USE: l� !--- - ----------- C O)----------------la_.._3�1L --.- APPLICATION FOR SANITATION PERMIT Permit No. 1 ----------------------r (Complete in Duplicate) --'-----'--!------------- -------- --'a -- This Permit Expires i Year.From Date Issued Date Issued f�i-/ 3o-r3 pip kation is hereby i Tacle to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance wit ounty Or i nce 549. J� JOB ADDRESS AN -LOCATION,.., �, w Owner's Name •rl/ I_- - P one Address -`---------------------------------------------- - i Contractor's Name -------------------------------- Phone.. Installation will serve: Residence ®/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .-- -__ Number of bedrooms Number of ISaths __ Lot size ________F --�{-�- ___________________- Water Supply: Public system [ Community system ❑ Private Depth to Water Table 6x—it. ft. Character of soil to a fdepth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ C y ❑ Adobe Hardpan Previous Application Made: (If yes,dote------- ------------V,No L / New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within 200 feet.) Jr ' Septic 1011t. Distance from nearest well --- from foundation_ _l___.__.M terial ± .--g--f"`t- -� --- No. of compartments.________= ____.____Size___ %X)lop.___---Liquiddepth._._ �-----.Capacity---0_' ------- r � Disposal Field: Distance from nearest well _ - Distance from foundation Distance to nearest line--s___..._. Number of lines______________ ___________________Length of each line_____ / __ - _ -.Width of trench___._ ..--__ . r Type of filter material__�1�/;ZJ�___.___Depth.of filter material_/_/-A--------Total length------ -L-__-__-__-----____ Seepa Pit: Distance to nearer# well-/ '�__.--_Distance from foundation_/d--1..__ Distance to nearest lot line- _c�_._ _ Number of 7 Ile Lining material-:�-C2 C A,�_.Size: Diameter.„ _.�._____.Depth.` _-14______ ------ Cesspool: Distance from nearest well--------------_-_Distance from foundation--------------------Lining material-__------------------------._____.___. ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid-,Capacity----------------------:----gals. `w Privy: Distance from nearest-well------_-----------r----------------------------------Distance from 7,arest building`_y___-------------------------------- a ❑ Distance to nearest lot line =-------•-------------------------------- - ------------------- A Remodeling and/or repairing (describe): ------------5 ---------------- --------------------- ---------- ------------------------------------------------------------------ ----------------------- ----------------------------Y-- ------------------------------------------------------------ - --------------------------- ------------------------- -----------------—------------- --------- I hereby certify that,J ave prepared this !'cation and that the work will be.done in accordance with San Joaquin Count ordinances, State laws, and r les and regulat ns... the.San Joaquin_Local Health District. E (Signed) ------------ _6rQ ---- ----- --------------------------------------------------------------- ---(Owner and/or Contractor) A Plo+ Ian, showing of lot,-f-- a ion of system �relation to wel __.________________�--------(Title)__.__ -_ ___..�. ----------------- (Plot ' By: ------'- -' ( p g l uildings, etc., can be placed on reverse side). FOR DEPARTMENT*USE ONLY � c r• ------------------ APPLICATION ACCEPTED BY-------- 'ccse ------------------------------------------------•--------------- DATE----, 6�------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------- ------------- DATE----- ----- BUILDINGPERMIT ISSUED----------------------------------------------- -------------------:---------------------- -------- DATE------------------------------------------------------------- 9 Alterations and/or recommendations:_-_ _�-rL - --. .-3____._.__. -------_ � ' -- � C - --=- - -- -------------------------------------•--------- ------ f ------- --------------------------------------- -------- - --------------------------------------------------- -- FINAL INSPECTION BY:....�, '' 't�_--------------------------------- Date----1- � .w SAN'JOAQUIN;ILOCAL HEALTH DISTRICT 1601 F.kaselton Avp. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi;California Manteca,`California Tracy,California l ES 9 IiEVISM 9-59 3M 3-'63 F.P.CO.