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FOR OFFICE_U APPLICATION FOR SANITATION PERMIT Permit No. .....................-7 ----------------------------------------- --------------- (Complete in Duplicate) 7 S --------------------------------------------------------- ' This Permit Expires 1 Year From Date Issued Date Issued ..... 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 AND LOCATION--- 7Ia--------- -------------------------------------------------------------•------...--•-------•--------------------------------------------------- ' Owner's Name _ --------- Address_-••-= _.. U 1 .......... zA Contractor's Name....... �.! [Apartment --- ------------•----•---------- Phone-----•--------------• -Installation will serve: Residence Housejii❑ Commercial ❑ Trailer Court [] Motel [I Other ❑ Number of living units: __V_. Number of bedrooms'___2_-N umber of baths Lot size4�_!�lA ----=----------------------------------- r- Water Supply: Public system .- Community system [] Private ❑ Depth to Water Table ST_ ft. Character of soil to a depth of 3 feet: Sand ❑ Graven❑ Sandy Loarn❑" Clay'Loam E] _Clay ❑S Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [B" New Construction: Yes Q- o © FHA/VA: Yes ❑ No E!��_, TYPE OF INSTALLATION AND SPECIFICATIONS: +; , , (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septi ' Tqn Distance from nearest well_________________Dstance from foundation_____'_----.-_--__.Mater.ia�l �,..*---._..-__.--_- ._....-_.-_-- ........ No' of compartments--------------- ---Size---------------•---------Liquid"depth------- ----- ------.._I_Capacity---------------•------- Disposal FiielI;I: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------.------ [rl ,,,/,4re! Number of lines-----------------------------------Length of each line-----------------_-.---_-----.Width of trench------------------------------------ �''�" ! Type of filter material__.___...________._.__Depfh of filter material-----------------------Total length----___-__._----____--_.___________-_- + i k -7-057" � �--------- See a e 'f ------------ Number of nearest well-/?1�!►t_____mDt lance from foundation_ 15............Dist ance to nearest lot line- -Cr 9 --- P ;� g ial----�a_f_t------Size: Diameter-- 3-��'-`J..........Depth----- ------ •--� Cesspool: Distance from nearest well----_-__-_-_---_Distance from foundation------------- Lining material-_.___----__--__----________-___.----. ❑ Size: Diameter---=----------------------------------Dept ------••------------- -----------------------------Liquid Capacity------------------------....gals. __jO I Privy: Distance from nearest well--------------------------_----------------------Distance from nearest building---__---______________________-__-__---_.. ❑ Distance to nearest lot line-- ----- I--------------•----------------------------- ---------- ) ---------------------------------- Remodeling and/or repairing (describe)=---------------------------------- --------------------------------------------------•----------}------------------------------------------ -----•-----•------------------------•------ -------I-----------•----------------------------- ----------- ~- ------------ --------•-------------- ` ------------------• =------------------------------------.-•--- •--------------------------- _i:: ----------- :--- =---------------•------ k I hereby certify that I have prepared this p lic Ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati n of a San Joaquin Local Health District. (Si ned --------------------------------- - Owner and/or Contractor p By•------------------ -- - ----------- ------------------ ----------- -------------------------------------------- {Title) f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- f -------------- ---------- ------------------------- DATE------ ,11� r l----------- ------------ ---- ------ REVIEWEDBY-------------------------------------------------------------------------------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDING.PERMIT ISSUED-----------------------------------------------------------------`--------••---------- ----------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---=------_: - ------- ----------- - =--"---------------------•----------..-..------••----------------------------•-•---------------------------- ------ --•----------------------- --- ------- -- ------------•--- -------------------------------------- --- -- ---------- •-••-- •-- (jam ' --------------•--••---------------------..._..--------•--- ------------------------------------------•---..-----------------------------------------=-----------•------------------- --••---------•---•----------- -------- ----- ----------------•-------•---------------------- ------- .•---------------------------------•--•---------; :---•------------------ •----------------------- FINAL INSPECTION BY-. Date Date ----------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California E9.9 REVISED 13.59 F.P.DD.ZM 6-60 - -