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- FOR OFFICE USE: I I �:- ' ° v I� APPLICATION FOR SANITATION PERMIT Permit No_ _________ . - {Complete in .Duplicate) _ -------------- -------- - - -�M = .. . = Da#e Issued 61 ._.__.-- __: This Permit Expires 1 Year From Date Issued Application is hereby madellto the'San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in cI mpliance with County Ordinance No. 549. r , I JOB ADDRESS AND C TION - ------------ ,( ------- ------- ----- }} Gl: -------------------------- Phone------------•--- --=----- Owner's Name. �. I_ }•�1 - ..' --------------------------------•---------------- (� ••- Contractor's Name--- ----------�4=4-C- --#----•��?-.Q_.u'�=---------------------•-------------------------------------------------------- Phone.------------------------------- Installation will serve: Resi�'-ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ dl d r� Number of living unA: __f._ Number of bedrooms �Number of baths __ Lot size .- = ------------- Water Supply: Public system [:] Commuriity system [_1Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand L Gravel ❑ Sary Loam ❑ Clay Loam [j Clay E] Adobe Hardpan ❑ Previous Application Made!. (If yes,dote_._________________1 No [ New Construction: Yes Rr- No ❑ FHA/VA: Yes,P----No ❑ II� ONS: TYPE OF INSTALLATION NAND SPECIFICATIONS: (No septic tank or c sspool perrMtted if public sewer is available within 200 feet.) / Septic Ta Distance from nearest-_well--�r_-_'`'Distance,from foundation=_�______l.Materia4__ _ _1 G_ No. oflcompartments__-_�- --------------Size_•___--- ��!��Liquid de 1?--=Capacity_ - -------- bf i Disposal F• Id: Distance from nearest well-_-.-�`__-Distance from foundation/O.&I___-_-__Distance to nearest lot lite_--_._____ Number of lines_--._______1___________ _ _____Length of each_line_;'____-,r'!' 'J'_____.Width of trench_ __ ___..-..______._-_-____ Type ail,filter.material____A_5 )4/) _Depth,of filter material=__.A---------Total length------ B_._1______-_-_--_____-__.. Distance to nearest lot line,.-___-_____ Seepage Distance to nearest ell.___r' --------Distance kym foundation_-___- .___. Linin material___(o_G _._5ize: Qiameter._ _ .......Depth_Q7 � ------- I Numbe�p of pits.__--_--�-_---- -- q t Cesspool: Distance fro114 m nearest.,well_______________ti_Distance from 'foundation---------------------Lining material-..____.._._----__.___----_______._. ❑ Size: Diameter--- -------------------------- De th........................ --- Liquid Capacity gals. Vl Distance from nearest well-___`,�_-----`--- ' -- Distance.from.nearest building-_____ ---------------------------------- Privy; ❑ Distancpe to nearest.lot line------- -F = ------ - --- --------------•- Irj i _ -- ._______- i Remodeling and/or repair g (describe :- �r � Wit' , xT --- ------------`- --------- -= ----- -- --� - ---- ------ ---------- ----- ----------- ----- - ( ------------- ------------------------------:;-------------------------------•----------------=------------- -----------— °----------------------------------------------- I hereby certify that I have prepared this application and #fiat-the work will be done in accordance with San Joaquin County ordinances, State laws, n r es and re la n of the San Joaquin Local Health District. - ---------------•--.(Owner and/or Contractor)z (Signed)-----------•------ - --- ------ - -- --- ---------------- - - ----- - -- - - ---------- - ----------------------------- (rit le)--- �. (Plot plan, showing .size of, , location-of•-system-in-relation+o-wells,buildings,-etc.,_can-be placed on reverse side). FOR DEPARTMENT USE ONLY SII ---------- -- ----------------------------•--------------------------------------- i. APPLICATION ACCEPTED BY ---------------- -------------------- DATE '` `��' REVIEWED BY u�� DATE PERMITISSUED----------------------------------------------- = --- DATE--------------------------------------------------------- Alterations and/or recommendations:------------------ ---- _____ &7 iY=16 - r_ --- -------- ------------------------- -----------••- -----------•------------?-• --••---•--------•-•-------•--- �l � ----- ,�— `[' -------------------------------------------- I ------------------------------------ -------------------------------- q' INSPECTION: BY:-.-------- i ____-----_--------- Dat ---_-------------- y` -SAN JOAQUIN LOCALH ALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California) Lodi,California Manteca,California Tracy,California ES 9 REVMED 6-59 3M