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VVK Uhf IC t U�it: --------- -------------------------- .� APPLICATION POR SANITATION PERMi 1 ° , -- - Permit No. ..�'._�?..::�?...':' ------ �-- (Complefe in Duplicate} r�✓' f ---- - - ---- ------------- - ------ --- --��-'!--r"�—'� ------------------------------------------------------- This permit Expires 1 Year From Date IssuedDate 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 -OCATION `K' --- == ='� ! '` r rj Owner's Name '• P =`j.: k' " f = ------------------------ -- -- hone. - f'=�' == ..--' J ------------------- - Contractor s Name-•-- _.............}__ '. :+-.-. _ ._._,_. fid=ti:. Phones ' Installation will serve: Residence 0,-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: :- Number of bedrooms .._...-. Number of baths -------- Lot size _# --------------------_C_,,..,_.r__._r.._--_.__-- Water Supply: Public system ❑ Community system ❑ Private Depth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ dobe 11-1'Hardpan ❑ Previous Application Made: {If yes,date......:.............l No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,�4No septic tank or cesspool permitted if public sewer is available within 200 feet.} 4itic Tank-- Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------- No.-of ..-._-__-..-__..-.__..-_-_----_-•---.-_________- No. of compartments--------- __Size___________ Liquid de th__________________________Capacity __--__.is`o$al. : Distance from nearTt well.-I.O.V------Distance from foundation._ -t- _-__Distance to nearest lot - fs?? Number of lines. ---:.---------- ----------Length of each j_--.Width of #ranch--<- - `-°'---------__-•.-- �. Type of filter material �Y__! :-_-Depth of filter material._///__"�--------Total length----------- -------___-.-______ 5eepag'p—Pit: Distance to nearest well--------------rf...._.Distance from foundation--------------------Distance to nearest lot line................. � • >"p Number of pits----------------------Lining material-----------------------Size: Diameter------------------ Depth-------------------•------ Cesspool: Distance from nearest well-----------------Distance from foundation.................... material----------------------...--.--__.-_-. Size: Diameter--------------------------------------De th-----------------`------------------------------Liquid Capacity-..-------------------------gals. Privy: Distance from nearest well------------------------------------------___-----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------- r Remodeling and/or repairing {describe,r - --------------- -- . •• -------------------- -•----------------- ..................... -------------- --.--•------- ------------ -- ---- ------- _� ----------- -.... ------------------------------- -------- ----------------------------- jl - ---- ------- ------------------------------------ -------------------'-•-- -------- --------------------------------- •-------------- - 14 I hereby certify that I have prepared this application and that fid/ work will be done in accordance with San Joaquin County ordinances, State I ws, and rules..and regulafions of the-.San Joaquin Local HealDistrict. /1 l Signed' ( .c t :__ and/or Confracforl ? 14 (Plot plan, showing size of lot, location of system in rel tio�fo wells, buildipfjs, etc., can be placed on reverse side). FOR fPARTMENT USE ONLY ----APPLICATION APPLICATION :ACCEPTED B�/. . .___�.. _ --- -- - -------------------------------•---- -- .._._ DATE--•�------ �"`---��....-----•----- �---- �-- REVIEWED BY_-. ------------------••--•----------------- DATE BUILDINGPERMIT ISSUED---------------- =------ ----- ---------•------------------------------------- DATE---------------------------------------------------- Alterations and/or recommenddations:-------------------- ---------- --------------------------------------------------••-------._.---•-•------------•-----•------------------------- -•--•--• ---------------------------•--------•- -----•------------------------------------------------------•----------------•--•-------------------------------------------•------------------------------------ FINAL INSPECTION BY:..--- - --. . Date----5�------_-15 --------"`----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreel 124 Sycamore Street 305 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 5-59 2M 5-62 ATLAS f