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R_OFFICE USE: r. ± ��------------------------ Permit No. . .. ------ -- - - APPLICATION FOR SANITATION PERMIT -- --------------------------------- ---- - - --------------------- --- ----- -:-- (Complete in Duplicate) Date Issued -------- - ---I-: -------------------------------- - ---- -------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. - ------ 1 11'�"�0--------� ,-------------------------•------------------ //--/------`---------- -j- -- Owner's Name---____-- -------- Address-- .------Address__ ------ ---------------- " t ------ --------•-•------------------------•------------...-----.-----•--------------------------•- 11406 Contractor's Name_____... _ _ Phontf- -•------ Installation will serve: }Residence E] Apartment House [_1Commercial Trailer Court [3 Motel E] Other ❑ J Number of living,units#jWe Number of bedroomsAWf Number of baths __If!�-Lot_size _____ PC_ _________________--__.._.__ Water Supply: Public,system K Community system [IPrivate❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [_1Sandy Loam [IClay Loam fV Clay [:] Adobe Hardpan E] Previous Application Made: (If yes,date----------------------) Not New Construction. Yes No ❑ FHA/VA: Yes ❑ No% r TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welINj0116_ .__Distance from foundation____, V- _.___.Material_____ ------------ ''// i No. of compar+mems-----------Z --------Size-TA__A-�------_---Liquid depth------- -- ----------Capauty_- .. . t Disposal Field: Distance from nearest well _Distance from,foundation____/_�_�_..___-Distance to nearest lot line___._..." I ! w (� Number of lines------------/----------- -- ---Length of each line----- ___.- "---.Width of trench---------_- - ---i_----- e�_ Type of filter material__ ®�� --__Depth of .filter materiaI___._Z_&__,-.-----Total length______________________�e---------- r t ` . Depth-------------1w->> _• d Seepage Pit: Distance to nearestYwell_, A73*� ._'Distance from foundation____�� Distance to nearest lot line__.____.__.__ 1 -------- Number of pits..--- -------------Lining mate rial ��---Size; Diameter_____-_ O i x Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------.-------- ----------- El Size: Diameter_._ II---------------------------Depth------------------------------------ -------------Liquid Capacity `--gals. Privy: Distance.from nearest well------------------------------------------------- from nearest building--------------------------------- Q It Distance to nearest lot line--------------------- -- �b g Remodeling and/or repairing (desc be):-.-_--- ------------- -----------------------------------------I-------- ---------- --------------------------•--------- ---------------------- ------- ---------------------='---------------------- ----------------;-----------• -•--------•------------------------------------------------------------------------- ----------------- ------------------ ---- -------------•--------------------------'------------------:-----------------------------------•---------------------------------------.------------------------- r ..,...,' ... �. 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. , ( -------------_.-__.(Ow er and/or Contractor) (Signed).. r ----------- ---------------------------------------- -- ----- -------------- - sY: (Title}._. ----- ---- --- -------- . ----- (Plot plan, showing size of lot, location.o system in.relation to wells, buildings, etc., can be placed on reverse side). - ;�FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ! _= ,r `"� ------------------- DATE ----�/__ U 4 -•--------------- --- I REVIEWED BY-------------------------- --- ------------------------- - -------------------------------------------- DATE---- -- -----------------•----------------------- ` r DATE--------�--`----- -"- i - -- BUELDING PERMIT ISSUED------------ — ' - -------- - -- rAlterations"and/or reco -------- ----- ------ Q— ----- �----'.7J------------ a -------------------- - `•-- ----- ! ZZ-14-, ------- ---------- E � ' -------------- -7 — 'Date r �. F1NAL INSPECTION BY: � r ---` _'._ ...' y }d k yy 1 •N .4-."k Z A b 4 3 S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Waselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi.California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F-P-C17.