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FOR OFFIC S c� APPLICATION FOR SANITATION--- - -- -�- ?.r-- --------------- --------------- �3 / / PERMIT Permit No. - l- ---------- /C = '�`% (Complete in Duplicate) �l �I ----------------------------------- .__-.._. This Permit Expires 1 Year From Date Issued Date Issued _-... .. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This a ADDRESS is kN nce with County r ante No. 49 pp P tY --------------•. ------------ JOB A6 -----•- ,f `` Owner's Name.- -----------------• -•-------------------------------- Phone./Y�---J__V Address--------------------------------- •--- .......----------- t ----------------•---- - - Contractor's Name_=�.l..R -- --- ........................ Phone----- ----------__------------- Installation ---------.._------------- Installation will serve: Residence Apartment House ❑.�,.,C�ommercial.•❑ Trailer Court ❑ Motel C1 Other ❑ -29 �^ ` Number of living units: ___ . Nu ber of bedrooms .--VNumber",�f baths ..1_.. Lot size ..._�_ �. --.�L------- -•-- Water Supply: Public system ommunity system ❑ Private ❑ Depth To Water Table 16-aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe 0 Hardpan ❑ Previous Application _ _on Made: {If yes,dote--.__.. .____._-- -) No E] New Construction: Yes ❑ No P FHA/VA: Yes ❑ No 17-1 G TYPE OF INSTALLATION AND SPECIFICATIONS: ] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------.--------_. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------•---- osSZ i Distance from nearest well_NOALI----Distance from foundation___ _._...Distance to nearest lot line---_..lp-.r ^' Number of lines____.J g r Len th of each line---- ---_•-........Width of trench---.. 4C---••------------- Type of filter material ._ __ __.__Depth of filter material..___ �r_-----Total length___ ��- -______/--_--____ y�pit Distance to nearest}�el l_�'� _.Distance from oundation___..___...._._.Distance to nearest lot line___--_ Number of pits_____!______________Lining material. _.___ Size: Dia meter_ _____Depth____.r�?U�------------•-- Cesspoal: Distance from nearest well_________________Distance from oundation________..__._____..Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity---------------------------- Privy- Distance from nearest well----------------------------------------- ..-----Distance fr m nearest building---------------------------------------... ❑ Distance to nearest lot line--------------------------------- ------------------------------ ---- ------------ -----••-------------------------------------------------- Remodeling and/or re airing (describe)---- ----- ------------------ ----------------- -------•---------------------•------...---•-----------•------------------------•-- -•----••-- __ _ ------ ----- ---- --------- ...-1 -----------------1�------------- ----------------- ---- : -_ _-------- -------..-------------------------- __%-------------------------------------- -----------= - ---- ---- ------------------------ --------- _ = I hereby certif that have prepared this application and th the work will be done id accordance with San Joaquin County ordinances, , an ules an4julationns oo#�thhee San Jo uin al Health District. ' (Signed)----------- --------------------• - ------- ---------e ---------------------------------------------- �2r Contractor) I3 - -------------(Title)---------------------------•------------.------ -------------- Y:---------------•-•-------------------------------------- ----------------------------- (Plot plan, showing size of lot, location of system in relat' n o wells, buildin 5VII. etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY "�—__ ,-____ _- c ----------------------------------------------------- - DATE------ � --------------- APPLICATION ACCEPTED BY____.__ REVIEWED BY----------------------------------------- ----------------------- ----------r---------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED c -.-•- `rDATE..- ._. - Alterations r recommendations:-•-- ?=. .E - -------t--------------------� ------------- ---_--------- -- �a� -� --------- ------ -7�c—��__..... - = — —. - c`� ,� 1-: FINAL INSPECTION BY:. --------------= Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Syreet 124 Sycamore Street 205 West 9th Strut Stockton,California Lodl,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-52 ATLAS