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rv>t vrrit-c u,,)t: -------------- APPLICATION FOR SANITATION PERMIT Permit No. 1233-T (Complete in Duplicate) --------------------------------- This Permit Expires I 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 comlince-,.with_ Cou�nrty: Ordinance rdinance No. p 549,49. ADDRESS AND LOCAN 's- ---- -�--- �Z ' '-_ Owner's `------•- ----- ---------- :-------- ---- D1.Ge�'Phone Address------------_------ - - -------- -------- -- Contractor's Name---'. -------------- ------------ � ✓ /- =.. ------------ ---------- s------ -ph-one Installation will serve: Residence 0 Apartment House ❑ '.ommercial ❑ Trailer Court E❑ Motel n Other ❑ Number of living units: I----- Number of bedrooms _A lumber of baths _-�_:_ Lot size Water Supply: Public system ❑ Community system ❑ Pr tem Depth to Water Table tF�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ , dy Loam ❑ Clay Loa mj Clay ❑ Adobe❑ Hardpan,. Previous Application Made: (If yes date________ E]______..._) No _,„plew Construction: Yes E] No E] FHA/VA: Yes [-INoE] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welit (l� Distance;from foundation----/ ------------------------ _~____ [ J No, of compartments___- — Size_! V _t'- ' -Liquid depth-------l... ------ y(r- ---Capacity--1 ---------- isposa Feld: Distance from nearest well.. ___0----_Distance'from foundation___-Ze)-_____- Distance to nearest lot line__*--..____. 0 Number of lines------- -----------------_------Jength of each line-__�_l'�.. -_--_-----_Width of trench_._A_:t? `__-.----____--_-- Type of filter materia L_ _ ?=_--- ' " �Avp ----Depth of filter material----.�-�- -.--_�o#al length---• a''g Distance to nearest well_./_9'?--`____Distance from fo ndation_-f "`' _- -._____.Distance to nearest lot line._S_-___..___ Number of pits----i-------_------Lining material- _/1- -_- ---Size: Diameter_.u_SC._- _0---Dept -I_ � -F � �--------- ------- Cesspool: Distance from nearest well_________________Distance from foundation------------------ Lining material_----- ______._-.--_._ ❑ Size: Diameter--- ------------------ -----i--------.Depth-------------------;---------------- --------------Liquid Capacity-------------- ------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building------ .____--________--___. ❑ Distance to nearest lot line--------------- Remodeling and/or repairing (describe)___________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- -------------------- ----------------------------------------------------------------I----------------•--------------------------------------------------------------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County L ordinances, State laws, and rules and regulations of�the %San �Joaquin Local Health District. (Signed)- °��` ------------------ Owner ---------------- - -------------- ---- - { and/or Contractor) BY ----------------------r/-------------- --------------------------------------------------------------- ------------Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... _.._.r_' r_r / `. . ----------------- ------------------------------------ -- DATE----- VIEWED BY --------- ----------------- ------------ --------------------------------------------------- -------------------------- DATE ---------------------- UILDING PERMIT ISSUED---------------------------- - --------------------------------------------------------- --------- DATE Alterations and/or recommendations__________________________ ----------------------------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY. _- Dater--_� --,7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California F.p.CC.