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FOR OFFICE USE: c�> - - --------------------------------------- _ ----------- APPLICATION FOR SANITATION PERMIT Permit No. 11. _ � -- ------- =-------------- ----- -------------- -`- (Complete in Duplicate) ----------------------------- -- --- ----------------- This Permit Expires 1 Year From Date Issued Date Issued •�I?!?AY Application is hereby made to the Sen{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. L If� �. JOB ADDRESS AND L TION_/ ___ __. __ ---------------------------------------------J ------------------••-------------------••- a Owner's Name------- li o ------ --•- ..... - -------------- =------------------ Phone--------------------------------•--- Address_.--•--V9 . e Contractor's Name...... ---- ------------- Phone--------•---------------------- ` t Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:l�..____ Number of bedrooms __ Number baths,2-Lot size Water Supply: Public sysfemlj❑ Community system ❑ Private Depth o Water Table ________ ft. a k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ S ply Loam Clay LoamrNC, lay ❑ Adobe E] Hardpan ❑t Previous Application Made: (If yes,date____________________) No New Construction: Yes E] FHA/VA: Yes F] No TYPE'OF INSTALLATION AND SPECIFICATIONS: pNo septic tank or cesspool permitted if public sewer is ra�vai!la�byle w�it.hin 200 feet. ) Sek: Distance from nearest well____ _d_r_eDistagce from foundation_-__/Q-- ------oXfo Mtil ------------ - 0---0--- --- --4 Nca mpartments_..__cr`_______________SizeLiquid de th_.._ --------- -- Ca acitY - Dlspos ,,Field: Distance from nearest well...s�____- Distance from foundation__ `0___.__.___Distance to nearest lot line_ ° O Number of lines-----------—3__- Length of each line_.'_____ dWidth of trench._%,,?---__ -_ g�j � a - 7----- t� Type of filter`'material_.rl,__ --,--Depth of„filter material__-_� _____-_______Total length___--- _ P � r Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------- to nearest lot line_-_.___._________ ❑ Number of. pifs--------- -----k---.Lining material-------------- ------Size: Diameter -- -`--------- Depth---------------:---------------- 0' Cesspool: Distance from nearest well----- __",'-'_Distance from ,foundafion`:Lining matetial_____ _____________- ___-_ Q4.. Size: Diame'ter_ ----------------------------------'p`-. YDepth.------------ -'-----------)---------------------ILiquid Capacity-----------------------------gals. rn Priv r: Distance from nearest well .______________`_-___ !a -_-Distance from nearest building : ❑ Distance to nearest lot line---------------------------------- ty i Remodeling and/or repairing (describe):------------------------------------------------- -------------- ;--: ------------------------------------ •--------------------••-----------------• � a i•= s ------ ------------------------------------- ---------------------------------- ------------------------------- --•------.---F ------------------------------••-------------------------- hereby;�certify that I have prepared this application and that the work will be done _------------------------------------------------ri _________County' : `in accordance with San Joaquin County' ordinances, State lawsaQd rules and regulations of the'San Joaquin Local Health District. t ly (Signed) --------------- ------ ----- ---- ------ ----------- -------------------'(ftnrand/or Contractor) . BY:- 6=- {Title} Plot 'plan', showing sizes.of lot, location of.SYS tem'iri relatio 05� # wells, buildin s, etc., can be laced on reverse side).- 'FOR ide ( p 9f t g p ). ” 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - --- -------------- ----- -------------- ----------------------- DATE---- G ----------------- REVIEWED BY-------------- I� ----- ----- DATE - BUILDING.PERMIT.�.ISSUED__--1� =------ -------- =w----_- --- -----'-----:'DATES--:LL- -------------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------- - -----------------------------•------------------- p ri t �t r 1 \ .i=----1-_ 01 --------- --------=- ---=---------------- y` _ ------- ----------------------- r Alk .. _ FINAL INSPECTION BY:- !" SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stacktonr California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-59 3M 3-'63 F.P.CD.