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DATE r APPLICATION ACCEPTED BY <br />.10.0 <br />FOR DEPARTMENT USE ONLY <br />REVIEWED BY DATE •• ••••••••• ••••• . 44* <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate' <br />This Permit Expires 1 Year From Date Issued <br />FOR OFFICE USE. <br />044 • <br />Permit No. . <br />Date issued <br />..plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. /.0 /„) - or 2-`r4 0 <br />t3 11-itG.A4 <br />JOB ADDRESS AND LOCA N CieYn t re.rx 4-23 Chat <br />Owner's Name M 17 <br />Address S:4-6 0 <br />Phone. <br />Contractor's Name................ <br />Installation will serve: Residence 0 Apartment House 0 Commercial 0 lrileGeert mot"! 0 ?flue <br />Number of living units: Number of bedrooms Number of baths • Lot the <br />Water Supply: Public system g Community system 0 Private 0 Depth), Wate;Jable ' ft. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam TA. Clay L'orlm 0 Clay 0 Adobe 0 Hardpan 0 <br />Previous Application Made: If yes date I No 0 New Construction: Yes 0 No 0 FHA/VA: Y63 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank:'- <br /> <br />Distance from nearest well <br />4o. of compartments..., Size Liquid de <br />Disposal Field: -stance from nearest well Distance from foundation <br /> <br />Number of lines Length of each line <br />Type of filter material — Depth of filter material. . Total length <br />Eta Phone...............-..... <br />NO 0 <br />Distance from foundation Material. <br /> <br />Capecity....g.4&2 <br />Distance to nearest lot line_ <br />Width of trench <br />Seepage it: <br />1:4 <br />Cesspool: <br />.ivy: <br />Distance to neares Distance from foundation Distance to nearest lot line <br />Number of pits .Lining material Size. Diameter Depth., i <br />Size: Diameter Depth • - Liquid Capacity gals. <br />Distance from nearest well Distance fram foundation \ Lining material . <br />, • ; - • , <br />0 e <br />Distance from nearest well ..... Distance .from nearest building f.... Distance to nearest lot line <br />....................... ........ ........ ..... •• -• -... <br />Remodeling and/or repairing fdescribe)- ',LP Ile ./..;;41.--P;To- , <br />..... . A..r..fin P- <br />5e lit, 1.11.A,k_k... 01.1 e.C.5 t-c.4t <br />1.6 Ver dicchiP?ee e <br /> <br />I hereby certify that I have preparedis application and that the workwill be' Of-TT-0 .in accGralince with SanJoaquin County <br />ordinances, State laws„ and rules and regulations of the San joaquin <br />(Signed) • - .(Owner and/or Contractor) <br />By ..... • ...(Title) .... <br />(Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can.' be placed on reverse side). <br />BUILDING PERMIT ISSUED.......—..-- DATE <br />Alterations and/or recommendations: 4644 <br /> 4.4 444404 <br />01444.44 * *44 *41 <br /> <br />... O.. .4,* Ar• • *ea.. a••••••••••• <br /> <br />FINAL INSPECTION Y: Date./ <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street <br />124 Sycamore Street 205 West 0th Street <br />Stockton, California Lodi, Califo rnia Manteca, California Tracy, California <br />ceS REVISES S-59 SM 15.0 ATLAS