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FOR OFFICE USE: Permit No. ___. --f. -- ------- -------- --------------------------------- APPLICATION FOR ,SANITATION PERMIT f ----------------- (Complete in Duplicate) Date Issued - _-_ This Permit Expires 1 Year From Date Issued 00/10f 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. lZ _ ,--------••------------•------------------- JOB ADDRESS AND LOCATION-_ _ •- 'G !� ----- ------ Phone-------------------------=----•---"- ------•-Owner s Name_____________ _ 'd - - Address--------_------- _ 'lam - -------------------- - - Contractor's Name___ -_ ._ _. .__ :. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i° Number of living units:,_.-/. Number of bedrooms _. ___ Number of.baths �_ __ Lot size -01-AP 4"'1'69 ----------- s` Water Supply: Public system ❑ Commuriity system ❑ Private Depth to Water Table'20-- ft. . ❑ Y y Adobe Hardpan A-: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam Clay Loam Cla ❑ ❑ ate_._.-._- _---_ No New Construction Previous Application Made: (If yesd : Yes ® No [I FHA/VA: Yes ❑ No ❑ f TYPE OF'INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) r Septic Tank: Distance from nearest wet _� ----DistgnF�J� foundation__--- ----------Ma�rlai_---------- - ��''ll Ir _ Li uid de th-_ -a CapautY . No. of compartments------ - -------Size_ Z' q p• 1.. F - 0 ,,I Vn f Cl--__-_-_-.Distance to nearest kat line__ ________-. b. ,` Disposal Field: Distance from nearest well-_-.� �__.-.-.Distance from foundafiion_._-__.•- Width of trench._=!------------------------- ------------- --------- Number of lines r____ _-- ----�- ----Length of each line____ .-- ----- r` Total length-- "I---�=------------------------ � Type of filter material t _ _ - Depth of filter material__-_-/__9-- ----- i Q'. __.Distance to nearest lot line______________ Seepage P't: Distance to_taeare elf .:.--:Disfiance fro ,Q, � ti++ r ?? �De Dept --- ------------------ Linin aterial---- -- ize: Dlame r--- - -------- ---- P" T ct`lu er of pits-----;*5'------ g � a ry Cesspool: Distance from nearest well_________________Distance from..foundation__ _---__-_-.Lining:material____---__-__-.-________-__________- p ❑ Diameter._t Depth. ------------------------------------ Size: Liquid Capacity gals. [ -----_- -_---_------Distance from nearest building------------------------- ------------ Privy: . .: Distance from nearest well------------------------ i -------------------_---- ❑ 0 arest lot line----- --------- --------------------------w: _ : = Distance #o nearest = ------• --------- ------- -- ------------------------ ----- ---•- Remodeling and/or repairing (describe)---------- ------------------------------------------- 1 ------------ --------------------------------------•---------•--------�.----------- n------------- ----- -------------------------- ---------------------------------------= =" _ - -------- ------------ ------------------------- -- : ------------ --------- ------------------------------ ertif that I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify LA ordinances, State laws, and rules end' regulations of the San Joaquin Local Health District. ` - (Owner and/or.-Contractor)-- (Signed) n r Contract ! (Signed)--•�r = ------------------------ -- = _ _ O ----------------- o a ---- � --------- -----[Title)----------------- --- ---- 10 ' (Plot plan, showing size*of lot,.location of system,in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY - 'p< t° "� ------------ --------------------------- DATE --------------------------- APPLICATION ACCEPTED BY_. . DATE------------ ---------------------------------------------- REVIEWED BY.-------------------------------------------------------------- --------------------- ------ ------------------------------------- ----------- -------------- BUILDING PERMIT ISSUED---------------------------- --------- DATE. - ----- Alterations and/or recommendations:___________________ ____________________ _ _-_________-___-__-_ __________ i ________________________ _______________________________ _______________----------_--------_-------____---------------------------- < - ... Date//-77. .--- ----- ---- -- --•-�._._ .__ --- ----------- --------- -- -- - - FINAL INSPECTION BY: -- ------- - " -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Streei� `° 124 sycamore Street 205 West 9th Street 1801 E.Hazelton Ave. Trac California Lodi,California Manteca,California y. Stockton,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.