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FPR OFFICE USE: a_r + ------ ----- Permit No. ------------------ -- ----------- APPLICATION FOR SANITATION PERMIT ----- ------------------- ------------- --------------- (Complete in Duplicate} - Date Issued -----------pp------------- ----- - This Permit Expire 1 Year From Date Issued A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t I This application is made in complian( wifih County Ordinance leo. 549.` r-y�� { A JOB ADDRESS AND LOCATION.----- -•----.--: t Phone--- � u��r --------------- -2---------------------------- ----- -- Owner s Name �..- --------------•---------------- ----- �'f Address ff •---- ------------- --- / one ---•----- ! ------•-- Ph • - - -"----------'-rte - - Contractor's Name---- -----•-------•------- r ' � / ' ' Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �( partment House ❑ �gommerciai ❑ tot size - -,. _ ------- f Number of baths r - Number of living units.: ---i---_ Number of bedrooms _- 1 Water Supply: Public system ❑ Community system ❑ Private' Depth to Water Table -_- - - {}• Gravel Sandy Loam ❑ Clay Loam El Character of sail to a depth of 3 feet: Sand ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date------------------ --1 No'lJ New Construction: Yes�No ElFNA/VA: Yes Prev ❑ Nor pp TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] t l Capacity1_-a --• f Se ti Tank: Distance from nearest well -.-.-'Distance frorr�fgu dation..:.................Miferyial---____ .-___- � No. of compartments-----�--- -- ------- Size-: 1- { ----Liquid depth 30 - �_F�'-_.--_Distance to nearest lot line-_ _ ------_ Distance from foundation- _�- G 7S 7 y Width of trench.2_fJ---------------------- D P Number of lines_=1 _-------------- ----------Length of ea ne7---�---iXA------•--- Dis osal Field: Distance from nearest well--) �ell�- . �^ Type of filter material_ -_! 1_._.= Depth of filter material-___fG------.-- Total length___1�_- •---------- a i r? Seepage Pit: Distance to nearest well_----__--------------Distance from foundation--__-_-______:..___:Distance to nearest lot line_---_-- __--_._ n Linimaterial---------- - - -------Size: Diameter-------------- - Depth-------------- ❑ Number of pits-------=-------- 9 Cesspool: Distance from nearest well----------------Distance from foundation_...------_-__----.Lining material------.-..-.---.---_----------•----- --- -.Depth-------------------------------- ------------------- Di' -g ------=----------Liquid Capacity---------------------------gals. i ❑ Size: Diameter--------- ---------- - .... T - --•------------ � •��"^"'�'SD's`ante from nearest lauilding�-�__- �'"� ice. I t - _ _ Privyi=.Y . ,. Y""'Distance.from nearest well-___.___ -----•------••--------------------------- - ❑ Distance to nearest lot line------------------------------- -- -�- -------�-- � 9r '' -----------------------••----•---- -------- I Remodeling and/or repairing (describe:--_-___-.- ---- -----------!-------------- ---------------------------------------------------------------------------- ------- ------------------------------ ----------------------------------••.....-..... { t - : --------------------- ---- --- ---- --------=- --------- - ---- I hereby certify that I have prepared this appiication 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 Health District. l �. _ s (Owner and/or Contractor) ed - (Sign - .._.-._ ------(TtI ------------------- t (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse-st e. _ FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-------------------- ----------------------------------------------- • DATE REVIEWED BY-------------------------------------------•----------------------------------- : f TE I BUILDING PERMIT ISSUED------------------------ DATE - -----------------y- -- - - Alterations and/or recommendatio_--n-----s-----:-----_----------------------------------- s:----- -----------•------- -------- ---- ------------------ •------------------- -- - ----------------- .-- Date FINAL INSPECTION BY-------- --- -------------- --------- ----- -- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 sycamore Street 205 West 9th Street 1b01 E.Hazelton Ave. Tracy,California Stockton,California Lodi,California Manteca,California ES 9 RZVISED 6-59 3M 3-'63 F.P.CP.