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FOR OFFICE E: " ----- �a �c _ .__` --- - - l_._' Permit No. --------a APPLICATION FOR SANITATION PERMIT � ------------•-------- -------------------------------- (Complete in Duplicate) - Date Issued -----------.` This Permit Expires 1 Year From Date Issued 111 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO r--------- �� 'i ,S',�1------j -... f ,C� I 1}�li---- ' WIt Owner's Name------------ '!� [ �' �°� l.' ----- �`��- g sl._/ , ..� -------------•-----....---••--............................' Address • �_ f � �'t �' 'l Phone. Contractor's Name._.-----•---•-== -a �7+i :� � -�----------•-----��-• __ .. Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Mo+el [3 Other Q ` f r� +x Number of living units..�1___ Number of bedrooms .�____ Number of baths ,1..-_ Lot size __._.___.__a_____________ .___.__.____......__......:__ Water Supply: Public system JCommunity system ❑ Private ❑ Depth to Water Table 56-Ti. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ] Clay ❑ Adob!30 Hardpan ❑ Previous Application Mader (If yes date______________.___.) No o New Construction: Yes m No ❑ FHA/VA- Yes ❑ No� I TYPE OF INSTALLATION AND SPECIFICATIONS: or cesspool permitted if pu lic sewer is available within 200 feet.) ,�} I Septic Tank: Distance tanDkstance fromnearest well___ _ ________ rom foundation___ .__.____.Material____ . .. ............................... istance f. , No. of compartments.. ....T�------ Size - g Liquid depth -•-•--.3 --•---------- CapacttY -�-� .. Disposal Field: Distance from nearest well_ ._.Distance from foundation----,iQ_ ....Distance to nearest lot line.•..7 ...... Number of lines--------- -•------------- Length ofeach`Ine_._.___„�` •--,-,---Width of trench..----- -��---.....__---- T e of filter material._. ___Depth oflfilter material-----0-----------Total length--------.2�______________•---_____-... Yp l , i ;. See age Pit: Distance to nearest-well___.,!_F' ___;__Diatance from fo ndation____j_ ....__..Distance to nearest lot Number of pits---------/----------Liining�,material__ if ---Size: Diameter. Depth_----�- --•.............. Cesspool: Distance from nearest well__---------------Distance from foundation--------------------Lig material----------------------------------- ❑ DiameterSize. - p --------1'---------------------------------Liquid Capacity---..... gals. Privy Distance fromnearest well________________ e__th^____-------_.f:--Distance from nearest building------------------------------------------ (� Distance to nearest lot line --------t ------•----- ^...�---------------- •---------- -------------------- --••------------------.. Remodeling and/or repairing (describe): ------ --.1. ; # -------•-•--•-•---••--•--------------•------- ---------•-•-----•------------- Mutt - --•---------------- ----------------.------------------------------------------------------------•----•-..---- -•-------------------•---------•--•-••----•---•------•--------...--.-------------- 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 Heal+Ii District. 4 (Signed)-��:-=------- F-•--------------------------•-------------------------------(Owner and/or Contractor -- •------------------------------•--------=---------(Ti+le)------------•---••- ..... ............ (Plot plan, showing sine o t, la ion of syste to elation to wells, buildings, etc., can be placed on reverse side}. R DE.ARTMENT USE ONLY APPLICATION ACCEPTED B /�•. - DATE ----------------•---- REVIEWED BY------------------------------------------------ -- ----- DATE ----------------- -- BUILDING PERMIT ISSUED_-------------------------- DAA � �- �, .. 1 •_. . Artgrations and/or recommendations:---Z':-------------- --- -=---- .- 1 __ eG� 1 ,- ---- '.....-- --- ---- � .____�_`1�'•F?-/ 1.. _ �!�<.� ^P ___.�.�•-_.l.,c?--.__L'{y_71�f_ .e. .G2..s_ y�7 ._'_______'__.---_._ _______________________________________________._ _ ._ __ ._.-_ __-__._.______---...._______.__--•--_-_.__ ----------____________________________________-------------_________________ _ ______________ ________________________________________ FINAL INSPECTION BY _____ ____ _ _____ Date__ . - SAN JOAQUIN OCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 9th Street Stockton,California ! Lodi,California Manteca,California Tracy,California r"it REVISED H-99 8M 8-67 At LA9