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FOR OFFICE USE: 9 ------------ --=----------- -------- ------ ----- � Permit No. --�-�-�-----'-- APPLICATION FOR SANITATION i-eRMIT ----------------------------------------------- (Complete in Duplicate). Date Issued __9//// ------------------- .--- This Permit Ex fres 1 Year From Date Issued Application is`hereby made to the San Joaquin 'Local Health District for a permit to construct and install the work herein escrbed. This application is made.in compliance wi h County Or •nance No. 549. fj4 = - - JOB ADDRESS A CATION. _ 4 t Owner's'Na -- --- -- - - P ne Address me a - ---- a •-------• - -------------- r� s _ / p ' 1 Ph Contractor's Name----- ------------ - •--•-•--- ► -------- --------------- - e Installation will serve: ;Residence.❑ Apartment House ❑ Commercial ❑ Trailer Court C1 'Motel ❑------ Other " Number of living units: _:-..___ Number of bedrooms -------- Number of baths -------- Lot_size ----------------,V-.._--..._------___----_----------_--__-_ Water Supply: Public system,Q Community,system ❑ Private�Depth to-Water Table r-. A. 1 + t r ! Character of soil to a depth ofr3_feet: and ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay C] Adobe E] Hardpan ❑ Previous Application Made: (If y s date-----------:--------Y .No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ '` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material__----_-_-----.__.--------_-_---_-_----------__. ❑ No. of compartments--------------�---r---------`Size-------------------------------Liquid depth---------------- --------,Capacity...--------------- Disposa Field: Distance from nearest well.--.?-®__--Distance from foundation._---a---------Distance to nearest Lodine-----_--__----_ Number of lines--=--------I--�-------_----�r-- Length of each line----S'$ _ ----Width of trench._-- -j_,..-------------------- _Type of filter material--- h-__Depth of filter material- `__.Total" length---,.5790____________________ ____ 9. I age Distance to nearest well__._�__ B------Distance from f undation..___ _____---.Distance to nearest lot line __J ❑ Number of pits--- --- ------------Lining Inate rial__ --Size: nteter_ �>��_.Depth__-___>✓a �- ------ Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material_-,-.---_--_------------_._-_----- ❑ `5ize:'D"'iameter: '' = ------- Depth Liquid Capacity gals. Priv _ Distance.from narest.well_- -.----.. _ -- ..____`----=----- ------- Distance from nearest building____.._____________._________.----__-_-- Y�•- e _ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------- ---------- r 'i eIng a pairing (describe):----------------------------------------------------------------------------------------------- ---------------•-----------------------------------•---- ------------------------------------- -------------------- • - -------------------------------------'-------------'-------•---------------- -•-------- ---------•----------------•-•- ------------=---------- -----------------------------------------------•-_------- --------------- ------ ....... I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules an regulations of the an Joaquin L al Health District. 4 a i (Signed) --- --- - - �7� and/or Contractor) 17 Y = _ - ' = --- (Title)--------•---------------- ---- --------- - ------------- (Plot plan, showing size of lot, locafi�offsyste'm in.re ati to well buildings, etc.,,can be placed on reverse side). € -1 'FOR DEPARTMENT USE ONLY r _ APPLICATION ACCEPTED BY - ---- ------ ------------- DAfiE -`5-----f --------------- ----------------- - - -- - - -- --- - REVIEWED BY f - ` - ----`--- - - DATE BUILDING PERMIT ISSUED--------- -------------`- ------------------- 4 DATE - e �_ Alterations and/or recommendations------- -----=--------- --- --------------------=---- __ --------------- --------------------I--------- ------------------------------------------------------ -------------------------- ---------------------------------------- ---------------------------------- _------- y 1 t` -----------------.-------...---------------------------------- -------------- BY:. Date---FINAL INSPECTION - ��. TM SAN JOAQUIN LOCAL HEALTH DISTRICT s ' 1601 E.Hazelton Ave. 300 West�ook Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Man tutor California Tracy,California ES 9 REVISED 9.59 3M 3-163 F.F,00. i5 l