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FOR OFFFIE USE: Permit No. �� APPLICATION FOR SANITATION PERMIT .• 5--•'Z __ __ ----- (Complete in Duplicate) Date Issued ------ ......�. ••--- "-" This Permit Expires 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 h�in del This application is made in compliance with County Ordinance No. 49. 21 L 's JOB ADDRESS L CAT CO ' ..fir ------------••----- •- �. :.. R Pho --•-....------ Owners Name_` +� - ' = ---•---•--------------------- f Address. - � �•- = ! -------- / .--- .------ PhoneLt:r s Contractors Name---------------------•--•------ --- ` 4• 1 .� Installation will serve: Residence Apartment House, Commercial ❑ Trailer ' aurt [] Motel ❑ Other Number of living unit `=_ _,Number,of,bedrooms ;. Number of baths ____ + + size ------_ ______ 4 '_ ft Water Supply: Public:system'❑ `Community system ❑ Private Depth to Water Table i de th of 3 fee#• `Sand [•] Gravel 0—Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a p e - FHA/VA: Yes ❑ No❑ Previous Application Made:.(11 yes,date______ __________) No [j New Cafnstruc+ion: Yes of E]TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . / Matejial_eA_.4_r..---- 1 =Y-------._-. Sep�t,i�c,/TaAk: - " Distance from nearest well�� .r.- -Distance from foundation-_1-4..--"-•- . Ca act ��C�-�• lam` Size..5 _ _. Liquid depth__. P tY , .,��No.•of compartments-•--- �-----------• - �• ---°�------ - r s l __...___..Distance to nearest lot lin ._ Disposal F Id: Distance from nearest well ___.__Distanc'e from foundatio __ __f Len th of each line._-- '�:=-----f.-----Width of trench.__ -- f•- Number of lines.�..i.__. _. - ------ - g - ---- ...... Type , s f I J, T e of filter matenaL.�_ �--�C-Depth of filter material.___��-'-_'--'--Total leng+h________________r.- � off Seepage ' Distance to neares#,well d0---------Distant m fun da tion__.._..: ,O-•...__Distance to nearest lot life. `J Size: Diameter -----•-----.Depth__ - P ---- Number of its_- _#._ _.r Lirimg materia{_� _ Q Die+ante from nearest well Distance from foundation--------------•-----Lining material-------------- ---------------------- Cesspool: - eW Liquid Capacity gals. ❑ Sizer Diameter__--- ---------------0'�-----•--.Depth----------------�---------•----- q p ty-------•---- •--•-- - - ----------- ------------ -:Distance from nearest building___________________________________-.- Privy: Distance from nearest well--------------------------------- _ -:� Distance to nearest. lot line---.'��< •----- -------- - -- y Remodeling and/or repairing (describe):--------------- -7------------------------------- ---------------•---------------W------------------------ -------------------------------- - - -----•----------•-••-•-.................... - ' i-!•t i I hereb erti y I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to thatws, and rul and regulatio s of the San Joaquin Local Health District. z t .(. _ ner and/or Contractor t (Signed).._ ------ ----------- (Plot plan. showing size of lot, location of system in relation to w s, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY i - -#'* DATE_.. wZ .•`-C!cz ------------ ------------ ----------- APPI KATION.ACCEPTED"BY___. --�`---- ------- i DATE REVIEWED BY.----••... .... - '-__..-> --- Df4TE. DING PERMIT ISSUED... . 1.1--------------- ---------------- _-------------------------------------- BUIL 4� l♦ _ ___________________ __ _____....._._....____.__._....____.__.. Alterations and/or recom endations: ----•-------------•---- i- --- - -- •- - ---------•--------.... --•---------------- ------- ---- ---- -------- +a'i �yr s ----•-------------------- , C -----------------I----------------... • �- FINAL INSPECTION BY:.---� !.... . •. . ----- ..... . Date_...19---'-T+ ff ------------- t r �S'AN JOAQUIN LOCAL HEALTH-DISTRICT 300 Nh Oak Sr 4 N - 4� Ir,124 Sycamore Street f 403 west 9th Street t 30 South American street �3 k . Tracy,California fViantecc California Stockton,California Lodl,Callforniai - , Eli 9 REVISED 8-59 i:M 5-41 AnAB