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rUK VFFICE USE: -------------------------------------- ----------------- ----------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No.. .......... -------------------------- ------------------------- ---- (Complete in Duplicate) Date Issued :-- � _--------- -- This Permit Expires 1 Year From Date Issued DSg G 9 p � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thg work herei?descrbed. . This application is made in compliance with County Ordinance No: 549. s JOB ADDRESS AND LOCATION__ ._ -_ _ --- C* ,-- Owner's Name- t ------ -- Phon ---- Addy ' Address = = u' I t Contractor's Name------------------------ --- --- _----- G e .----- -��± -- ---- - --------------- Phone----•-----------�------- ! Installation will serve: Residence Apartment House ❑ Commercial Trailer ourt ❑ Motel ❑ Other Number of livingunits: _- __ Number of bedrooms I 1. Number ba+hs -------- .Lot size -- Water Supply: Public system ❑ Community system ❑ Private d Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date......--------------) No ❑ New:Cons+ruction: Yes ❑ No ❑ FHA/VA: Yes ❑ E] _ No TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permitted if public sewer is available within 200 feet.)F.,- . N SepticTank: t nearest _.Distance. from foundati� ----------------- Material ------------------- } El Noof comPartents . - - - eiC �----- -��---- tUdp ------------ ------------Capacity ----- G i Dispos Field: D+stance from nearest weil._e5-----------Distance from.foundation_--_ g tion----,Ie------ to nearest lot`n Number of lines------- ---WIT Length of each-line____~ !�:___ _._-.Width of trench------ __ _________ '_____..- Type of filter material----��,r-_-'Depth.of;filter material `� Q r, Total length -------- SeepagePit: Number "forest well - Lining Distance m found � p `� # ❑ -----•-- P g ¢e: Diameter-- ----:-�- - --------..Depth-.----�--- -------�--- ---'----.. a ion______________ _____ istance to nearest lot line______- Cesspool: Distance from nearest well-_---------------Distance from foundation---.- --.Lining material Size: Diameterf ____. ._ ----- ----------------------. --- ----Liquid Capacity -- els. Privy: Distance from nearest well---------------------------------------------- Distance from nearest building---,------------------ --- :- ; ! I ❑ Distance to nearest lot line-- ------ -----•------------••----- --------- t Remodeling and/or repairing (describe) --------------- = - -=---- _---=---------••--------- -••------- -------------------- L -- �_ k -- --- I -----------1- - ---------------------------•--- ----- ----------.------------ hereby certify t I have end regulationapplication the San Joaquin the wok will be do --------------------------------------------------------------- - --ccor- - - -- Sa -ui - t - o done in accordance with San Joaquin County ordinances, State ,,a}t rict. (Signed) „= ------ - ----------------------------------=--------------- - - tier r ract ) `•=- o Cant or 9► ay--- ---------------------------------t--=--• Title ' (Plot plan, showing size of.lot, location of s stem in rel i n to wells, buildings, etc.,•-can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -----------------------------------=----------------------- DATE-_-Z-3-D--� REVIEWED BY-------------------------------------- ---•- DATE------------------ BUILDINGPERMIT ISSUED---------------I------ ---------------------------=---------------------•------------------------- DATE------------------------------------------- -------- Alterations and/or'recommendations:------- -----------•-------------------------.------- - -------- -----------•-- ----------••-------------------------------------- -------------------------------------------------------- -----------------=----------• ------ -----------------------=------------------ -•------ ' ----------------------------------•------------ -------------------------• ------------------------ ----- ------ ------------------ FINAL iNSPECTION BY:e---_--- -Ao ____._._-------------------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 3M 3-•63 F.P.CD. • F