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FORA:. C USE: a ---3�, - -- APPLICATION FOR SANITATION PERMIT Permit No.,./ - -- ----------------------------------------------- (Complete in Duplicate)- _' Date Issued .,--- This Permit Ex ires i Year From Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATfON_______ ____ ___ -=------••------------- Owner's Name -ems - E - -- -- - µ P 'T. _,�� -� Address------------------- --- -------- -----it------------- - - \_ im Contractor's Name It ' `d - f` t-- ----•----_-- Phone.._--•---••-----------•---------- f. Installation will serve: Residence partment Hoti use Commercial ❑ Trailer Court ❑ Motel El- Other ❑-. Number of livingunit-JI--- Number of bedrooms _____ Number of baths ___I Lot size --- s-_-__x•,��-_•----___- -__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 0 ft. Character of soil to a depth of 3 feet: ;.Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe Hardpan El I Previous Application Made: (If yes,date___.___'_____________] No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i :1 ' t S Ic T Distance from nearest well________..__-^-_Distance from foundation____________ _____.Material___-_-.__________-_'____----______ . _;______.. No. of compartments-------------- -----------Size--------------------- ------Liquid depth_`-._.-;- ---------------Capacity---------- s I Distance from near it welL4S��Distance from foundation.._ Distance to nearest lot line____ f lines____x____ Length of each line_ r P g 1 - .:Width of trench Type.of.filter material._ _ : _ - Number o: Depth of filter material---,-_ - ____Total length_____________-.� Q- ---_---__ r Se e Pit: Distance to nearest well_k_ ---------------Distance from foundation--�O:________-Distance to'nearest lot line_:_.___..• p g '"Number of 1pits._.�__t_____________Lining material_________+__ Size: Diameter._,t�3_ ___.__.De `.------ t Cesspool: Disfance from.nearest well----------------- fro foundation____________________Lining material_-_----- _____'_-__._____- -_ m El Size: Diameter--------------------------------------Depth---------------------------------------- = -- ----------Liquid IlCapacity----------------------------gals. , Privy: Distance from nearest well-------________!_______________-__.___.____._.__Distance from.nearest building---._.______ UJ ❑ Distance to nearest lot line------------------------------------------- Remodeling and/or repairing [describe): -----•------------------ •-=-- .Ti j _ ----- - � �- --g- - _------ _- t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulations of the San Joaquin Local Health District. (Signed Y ""�' � A-sf 1- 7- - ----- ..__ - {o -------� -------- r Contractor) _ �I tact By:-------------------- -- -- --u----••--- or - - ------------------------- -�-------- -�Iis, -� -�----�- --•--(Title)--�------ --- - ---- ----- - .(Plot plan, showing size of lot,.�location of system in relation o wildin , e ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----. `-q AV-1-------=------------------- I-------•------ - ---------.DATE-------- f_'---�----- �--- �'-------..---------REVIEWED BY ----------• ------------------ -------------------- --------------- ----- ------------- DATE BUILDING PERMIT ISSUED-----------------------------------------`------------------------- }---------------- € DATE Alterations qnd/or recommend' do s:--------------------------------------- ------ -- - ----- ------------------------------ ----------------------------. - - -- �- -- --- ----- •-------------------------------------- ------- ---------------------------------- ---- --------------- - -- ----- ------------------------ -- ------------ i FINAL INSPECTION" BY: ------------------------- Date `, . . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CD. , 2