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FOR OFFICE USE: /`I r '/�r -2y7'd /I,�,- i ' - --- -- Permit Na. ... _ �- -- - -- (Complete APPLICATION,.;_..:. SANITATION PERMIT I "- _-_--- •------,-'- -_-- (Complete in Duplicate) r - ---------------' _ Date Issued ---------- Application This Permit Expires 1 Year From Date Issued A lication is hereby madel� ' i pp y �ifio the San Joaquin Local Health District for a permit to Construct and install the work herein described. This application is made in ompliance with County Ordinance No. 549. p 1 JOB ADDRESS D CATI �_ ------ Name----- --------------- ----- ------- ------------ Phone-------------------------------- r Address "`� ------- -- ------- ------------------ ------------- ---------- Contractor's Name_��---�-- _ - `� -------- ❑ Motel Other Installation will serve: Resilience Apartment House Commercial Trailer Court ❑ ❑ ❑ Number of living units: _ _ Number of bedrooms __Number of baths,________ Lot size :__��-----------••----- -- 4 . _ �-__ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. ,i Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam [_1 Clay Loam [I CI ❑ Adobe Hardpan ❑ 1! Previous Application Mader (if yes,date. --- --__..__--__-} No ❑ New Construction: Yes E] No FHA/VA: Yes [j No El TYPE OF INSTALLATION11AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank_: Distance from nearest well -Dista e m founc;Ation__j_l0____ -Material____ _ _____ i No. of�compartments__�_-_--__ Siz ` Liquid depth-�?` .C1. --------Capacity---- --�-•-- Disposal Yield: Distance from nearrst well.-_M4� Distance from foundation...��-------- Distance to nearest lot line_____ Numbekr of lines---- _____ _ __ _____._Length of each line_- p_i--------------Width of trench.__T f - -------------- De th of filter material_____ __ �__Total length____L-------- --- -------- ------- 7 e of filter material +__ p r l Seepage It: Distance to neare t well-#4rx .1-_-._--Distance from foundation____ _--Q___.__..Distance to nearest lot line__- __ /f V1 Number of pits_-_---- ------------Lining material _ _- __ _- Size: Diameter-___. _ _,.;--E�ePth--- r. Pr N'` Cesspool: Distance from nearest well________________Distance from oundation-__._-----____----.Lin-sng m terial----------------_-______-----_.____. ❑ Size: Diameter---- ---------------------------Depth---------------------------------------------=------Liquid Capacity- --------------------------gals. Privy. Distance from nearest well-_----------------------------------------------Distance.from nearest building------------------------------------------ ❑ Distance to nearest lot ,line-------------------------- ------------------ ------------ i ----------------------------- 11 Remodeling and/or re aiIing (describe) ----- ------- ------- --------_--- 11 ax _ y , - ---- ---------- - ------ --- -------- ------ ------ ---- ----- ! hereby certify that I have tprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aril r les and regulatio of the Sa*wels, n Loc Health District. �P � 1 Contractor -- --- ( ) e-1 ' -------- �- 13 --------(Title)----------------------------------------------..- ----- Y:--- ----- -- (Plot plan, showing sue oflot, location of system in relation building etc., can be placed on reverse side). .i FOR DEPARTMENT USE ONLY G n ------------------------------- ------ DATE--------=-/---_�` APPLICATION ACCEPTS REVIEWED BY----- Y--- T--------------------------'---- ------'•----'- -'- ---------- ----'- -'------ - -- -------------- �----`Y-'--"- DATE -------`--_----••--`-------'----.L------------ ---------- ------- iBUILDING PERMIT ISSUED----------------------- --------------------------------------------------- -- DATE--------------------C------------------------_--------------- -----'--------- '��'a---- ---� �I -�----------------- C �--- ,�._- Alte n - -- ------ ----' ----------------- -e =----'-- ----- � -----. •-- ------------ ----------- , w - FINAL INSPECTION BY:...... c.-, s- --- --- Date- I - SAN JOAQUIN LOCAL HEALTH DISTRICT - 1601 E.He A Vie. 300 West Oak Street 124 Sycamore Street 205 West 91h Street, i i 5tocklon,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P•C d. ' I 4