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to U"KIC USE; ----------------- ------- ---------------------___-___ APPLICATION 9OR SANITATION PERMIT Permit No. . G ` (Complete in Duplicate) /-,x- --------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ._...__............._..... 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 LOCfjT10N.. Address _.G =-- Owner's Name..........`1-• -- --------- -------------- ------------- Phone..........................._ . ' ---------------••-- ----- -----------� ----- -•-•i -. A .�i� ------- Contractor's Name.. .� �7 F � - Installation will serve: Residence ®I Apartment House ❑ Commercial ❑ Trailer Court _❑ Motel [I Other [3 ) Number of living units,. _I_..__ Number of bedrooms _�- Number of baths Water Supply: Public system ❑ __�..__ Lot size __ t - ----••------ Gommunity system ❑ Private IN Depth To Water Table 2-:P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [N Clay Loam ❑ Clay 0 Adobe[] Hardpan ] Previous Application Made: (If yes,date____________________I No Z New Construction: Yes.M No ❑ FHA/VA: Yes ❑ Na ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 40?V nk: Distance from nearest well._________________Distance from foundation----_------------- - No. of ompartme nts------ i----------------Size--------------------------------Liquid depth- Capacity.._._..__.... Dispos F' ld: Distance from nearest wellt,:O ----;Dist from foundation._ D_t--____.Distance to nearest lot I;n'e.-jr__.__.. Type Number fines__ -_, `_° Length of each line___�_�-,�-------------Width of french---Number o of ilter maters s �l Depth of filter material----/Z_"-------Total length__1__�- ----------------_•-__-- eepage Pit: Distancerto neare t`we _ _i `Distance from foundation-------------------.Distance to nearest lot line---------- El Number of'pits` '.'___,.__'._____Lining material___________________ Size: Diameter__---------•-----------Depth---------------•------••---_--- Cesspool: Distance from wrest well_________________Distance from foundation--------------------Lining material________-____________-_______ 0 Size: Depth---------------------- ------------------------------- Liquid Capacity gals. - g Priv - arest wel----------------------------------------- -_----Distance from nearest building Y� Distance from nearest d n ----------------------- Distance to nearest lot line g --------------------------------------------------------------- Remodeling and/or repairing (descril)--------------------------------------------------- .-•--•-----••------------•------.-----i y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. (Signed)_ ---------- -- .---- --•-------- ----- BY:------- •- - ---• -(Owner and/or Contractor] -----(Title)----•----- ------•-----------------........ (Plot plan, showing size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._ _ ----------------------- DATE -8-_.""L - REVIEWED BY I DATE------------ BUILDING PERMIT ISSUED---------- "---------- -------•-------------- DA•TE ---------•------------ A erations and/or recommend'ations:_---! - ---- --------- - ------------------------ ------- ------------ --d---------------- ------------------ --------- - FfNAL INSPECTION BY___ _ ________ ___ --------------------- Date_/a.. —O "rr . t SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street i Stockton,California Lodi,California Manteca,California Yraey,Caiifornfa I ES 9 REVISED 8-59 2M 5-62 ATLAS } S