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r OFFICE USE: ----_- -----_.- APPLICATIOK FOR SANITATION PERMIT Permit No. .. -------- (Complete in Duplicate) ` --- ----------------- ------ �;- This Permit Expires i Year From Date IssuedDate-Issues! ___- . 1 Application is hereby made t8' 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 - ------------ ----- - Owner's Name-- Ifs • . !_. :_ 7�---- �.-------------------------- ----------------------------�--------------------•-------------•----------•--------••------- •-•--�-- XA Address------------------- � Ph " Contractor's Name____ .. _ i -------..__. -----•----- - — o ------•-------------------------------- PhoneW. - Installation will serve: Residellllce Apartment House ❑ Commercial ❑ Trail, ourt ❑ Motel � ❑ Other ❑ Number of living units: . .. __ ber of bedrooms _ _ Number of baths Lot size f 22 ----------------------- : ----------- Water Supply: Public sys#em Community system ❑ Private ❑ Depth to Water Table _ ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan ❑ f i "--M { Previous Application Made: (I yes,date____________________1 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.) is T Distance fro11 m nearest well________________Distance from foundation__.___________.___.Material___.________._-__.____ No. of co�Ipartmenu ----Size--------------------------------Liquid depth--------------------------Capacity Iii ....................... D' os iel : Distance f tom near, t wefl_4t1s�Distance from'foundation____ ! Distance to nearest lot line___ r� Number of lines___..__ _ ___.__ _ Length of each line___ _ s� �G� --------.Width of trench_,"--' f. Type of filter materia _ _ . '�� r el __Depth of filter material______ -_-_-__---_Total length________________ �____________--- ag P Distance t��nearest -------- ________Distance from foundation_.:. __ f �f�_._.______.Dis c� o nearest lot ii e Number of!�pits__._I___,___.._____Lining materiaLR4? _______.Size: Diameter__ Depth_ -__--.-_-___ � i -----. Cesspool: Distance fil`om nearest well_________________Distance from foundation---.__.__--__-___-.Lining material___-_____-_.________________________ ❑ Size: Diameter------- ---- " - Depth_------- ---- ---- Liquid Capaci#Y -------- gals. ---------- Privy: Distance from nearest well___________________ ❑ _______________________________Distance from nearest building----_-------------------------------------Distance t .nearest lot line--------------- ------------------------------ Remodeling and/or repairing [:describe}: } - ------------------ ---- ---------- ---------------------- -- --V-2 ----------------- -- I hereby certify that I halt, prepared this application and that a work will be done in accordance with San Joaquin County ordinances, State laws and r Dandregulations of the an Joaquin Local Health DistricL J l -��--�---- -r--------- -- ��.---------- „� ar Contractor) By:------------------------ d (Title plan, showing six, of.lot, Id11cation of system in relation a Is, buildings, ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .B1,1__._..____ _- _-t s a`' •� ---------------------------------------------•---------------- DATE-------_4.7 ---- REVIEWED BY -- --------- --'------------- .- DATE- -- - -- ----- ------------------------------------------------------ BUILDING PERMIT ISSUED______,�� ---- ---------------- D Alterati n and/or re mender ons•-•---- -- -- -- ---- --- • --------------- ---------------- ------ ------------------------------- ----------•-------•-�� ------- -� _�/ �------.9-- =--------•------------------•-------- ----•----- --- ------------------------- ------------:----- -------- -- FINAL INSPECTION BY:---------- --------------------------------' �cJ Date -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxolton 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.gp: