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--,APPLICATION FOR SANITATION " IMIT Permit No. ------------1-11---------------- ---------- ----------------------- -----------------I ---------- (Complete in Duplicate) ------------- --------------------------------- ---------- This Permit Exeires I Year From Date Issued Date Issued Application is here6y'riala 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. e- JOB ADDRESS AND LOCATION,_ ...... ------ ------- Owner's - Name -:�------ ------------------------------- --------------------- Phone.................................... -- -- .... .. .. .... Address_.__.r..- 4- -- -------- �...... -- -- -- . Contractor's Name--G ---------- -)Phone.............................. Installation will serve. Residence El Apartment House E] Commercial El Trailer Court El Motel C3 Other O( -6--Z Number of living units: -------- Nu�ni5e`iofA biedrooms ----------Number.of baths -------- Lot size ------------------------------------------------------------ "-, 't�, Water Supply:-Public'systern 0 :Community�-system-E]_PriyafeiN-� -Depth-to Water Table 41�7f- - - i Character of Will to a depth of 3 feet: -Sand E] Gravel E] Sandy Loam 19'ClayCoa_m_ C]' Clay E]- -Adobe[3 _Hardpan 0 . Previous Application Made: (if yes,date_------------- 'No [I New Construction:: Yes a jNo ❑ FHA/VA.- Yes [3 No E] TYPE OF INSTALLATION AND SPECIFICATIONS-. sil (No septic tank or cesspool permiffed'if public sewer is available within 200 feif.) 0 Septic Tank: Distance fr6m nearest well.__-//_C)-------Distance from foundation... ..... .... I -----� o�' _ -ft stance prqu6;7�,3r,Disposal Field:. "D .fromnearest well__q,0_'/._Disfance from foundation... .... ....umber of line s----:-,2-------------------------Length of each line---- 1.,20__'_---'---.Width of french.....�2......................... Type of fiIf�;rmate`rW.'9&_-r_A-------___bepth of..filter material---- -----Total length........ --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance-to nearest lot line................. Depth---------------- El Number of pits___.________- !�___Lining material-----------------------Size: Diameter__-._..-----__.---- ----------- Cesspool: DistanA from nearest well-----------------Distance:from foundation-------------------Lining material--------__---__----i............... ❑ Size: Diameter-----------------------4----------- Depth-----}----------•-----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------- - -----_----__-_-Distance from nea�est.building--------------------Distance to❑ Tea—re-�'si"lot .line-—-------------------------------------------------------------------I------------------------------------------------------- -- ----------- Remodeling and/or repairing (clescriblP--------------I--------------------------1-1-11,-------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --- - ------- ................1-........................---------------------------------- ----------------------------------------------------------------------------------------------------------------- - 'I Z ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and''regulations of the San Joaquin Local Health District. (Signed).. A - r ---- --------------------------------------I--------(Owner and/or Contractor) ----------------------------- --------- BY:---------------------------------------------------------------------------------------------------•-•----------------1:-------------(rifle)----------------------------------------------------------------- (Plot plan, showing size of lot, locat;on'of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------------------------------- DATE_.._ -------------------------- REVIEWEDBY------------------------------------------ ------------------------------------------------_-------•--------••---•-------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------- -------------------------------------------------------------... DATE-----------------------------------------..................... Alterations and/or ,ecommenfalions:------- ------------------ .0---.----------- --------- ......... .... .....................................------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ..........------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ......................I-------------------------------------------------------I--------------------------------------------------------------------------- ----------- ------------------------------------------------------- -6.-2--------------------------------- .Je!_ ------------ Date ) FINAL INSPECTION BY:... ------- 99SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISEO 8-59 RM 5-61 ATLAS