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FOR OFFICE USE- ------------------------------------------------------- -- Permit No. ..a. ...... APPLICATION FOR SANITATION PERMIT .2 --------M----------�-------- (Complete in Duplicate) ------------- -- Date Issued - ------------------------------- ------------- ILA This Permit Expires I Year From Date Issued. v- bed. Application is hereby made to 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 ANDOQATION---- ---- Phon ... Owner's Narne_------------------------ ----------------------------------- ------------------- Address----------------_- - -- ...... -- ----- -------------C. Contractor's Name-------- _--------- ------------------------------------------------- --------- -------❑--------------------------------------------- Phone----------- ----------- R ..K Apartment House 0 Comm ( Trailer Court E] Motel Other [I Installation will serve: esiden etT,81 � _ Number of living units: ____l-__ Number of bedrooms umber of baths _j- Lot size '.----------?__5--- -------- 171 Water Supply: Public system �El ,Community system E] Priv a te��Depth to Water Table ft. Character Character of soil to a depth of 3 feet: Sand E] .Gravel El Sandy Loam El Clay Loam [] Clay El Adobe Hardpan Previous Application Made: (if yes,date--------- -----------) No �& E] New Construction: YesNo FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Mate r'a --- ------- Se f Tank: Distance from nearest well___ ___L. Dista from foundation____ _7 N6. of compartments__________. - X- 0-- .Liquic ,cepth .... - --Capacity Disposal Field: Distance from nearest well Disfa nc'e from foundafion-----,�n-,.T'--.Distance to nearest lot IjnQ ine --Width of trench j__"-._"_------ ` Type of lines-------- _-- Length of each line-- ---------[, / ___0---------- ------------ -- --- ._(&pth filter material___--1- __,__.Total-I-----Total length.------1-4 Type of filter. . material_}--,--- , , t .jo nearest lot line_:_________-_.- Seepage Pit: Distance to:nearest well--------------�__�:_-;-Distance from foundation-------------_____--Distance. Number oi p'ifsl------------------------ ------------------ --- Size: Diameter----------- Dept ---------------------- El Lining ' a a ---------------------------------- Cesspool- Distance f��P :nearest well-----------------Dist nce from foundafion- ------------------Lining materi, Size: Mameter------ -------------------- ----------Depth - ---------------------------------------------------Liquid Capacity ------- ----- ------------•---gals. El - r - Priv.❑ y: Distance Trorn, nearest well__-_-- --------------------- ---------------------Distance from nearest bui 9-------------------------MM-------- Aj- ------------------ --------------------------------- ---- ❑ Distance to nearest lot line------------------ ----------------- ------------------------ -------- --- - Remodeling- and/or repairing [describe)----------------F:.-------------------_;------------------------•---------..-------------------- 7-----------------------M---------------------------- ------------------------------------------------- ------------ ------M--------------------------------------------- -------------------------M------------------M------------------------------------------------ ------------------------—------------M---------------------------------- ---- ---------- --------------------------------- ------ --- - ----- -------- -----------M_------ -------------------------------------------- ------------------•------------== -----------------•- -- I hereby certify that I have prepared this.�pp I icafion andAa�t'thre work will be done in accordance with San Joaquin County ,I;t* sof the San Joa qui oval'Health District ordinances,. State laws, and rules and regu aT ----- ---- ------------ ------M---------------------------------------(Owner and/or Contractor} (Signed)------- V- -- - -- ----- By:---------------------------- --------------------------------------------------------- --------=-------------------------------------(Titlel---------- -------------------- -------- ....... (Plot plan, showing size of lot, location of system in reElatioto wells,_buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------ -- -- --------- ---------------- APPLICATION ACCEPTED By----------------------- --- ---------------------- ----------- ---------------------- DATE------- - DATE-------q ---------------M------------ REVIEWED BY------------------------------------------------------------------------ -------- ------ - -----:--------------------- - ------------------ M-------- BUILDING PERMIT ISSUED-------- ----------------------------------------------------------------- - ------------------ DATE -- Alterations and/or recommendations------------------ --------------------------------------------------M------M---------------------------------------------------------- ------------------------ -------------------------M---------------------------------•------------------------ ---------------- ------------------ --------•------•--- --------- --------------------------------- 4 -------------I---------------------------M------------- ------M-M----;_---------------------------------------------------------------------------------- ------------------------------M---------- --------- - ------------------M---- ---------------------- ------- --------------- ------------M-------------------------------------------M---------------------------:--------------------------------------------------M------ - ---------------------------- M----- - ----------------:---- ---- ------------------------------ ---------- ------------------ -------------------------------------------- ----- - ------------------ -------------------- ------ ------------ ------ ---------- FINAL INSPECTION BY------ ..... ---- -------- Date -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mant California Tracy,California ES 4 REVISED 8-59 3M 3-'-3 F-F CD.