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�O�R OFFICE USE: �� d� 1 �� --- - --- ------------------------- ------- Permit No. .. vuu ------------------ ------------------- �•�p - APPLICATION FOR SANITATION PERMIT ----=---- ---- ----------------------------- (Complete in Duplicate} Date Issued ----- is here- made to the San his Permit Expires 1 Year from ate ssue Application y Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinancte No. 549. JOB ADDRESS AlION-------•--------�--�---,---�--•-�•------- ---- -------------•---------------- - -------- ------------------ •--------------- 7ifJ °C:Ut `_ .!1 'i1_ _ T L Phone Owner's Name--- •- - ------11--- Address--.---' 7 ------- --- Phone__..--------•-------------- ----- ----- ----•--- Contractor's Name--------------•-----------•--•--------•-------•-------•-ou :. Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other �`' Installation will serve: Residence ❑ ; p ❑ � -4 ----------------------- Number of living units: -------- Number of bedrooms -------- Number of baths --- Lot size .____: _ �. Community stem ❑ Private [I Depth to Water Table _ ft. Water Supply: Public system ❑ y s Y Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ElCla Sandy Loam ❑ y Loam ❑ Clay ❑ Ado-ef Previous Application Made: (If yes,dcite--------------------) No New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No ❑_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__ v_____Distance from foundation______--___.Material_-_--____________________ ________________.p Li uid de th--- Capacity l ```-� .. No. of compartments_._.__Z_--_----------Sixe_S.SfA--------------------- q P. �--- -- - ��- t r Disposal Field: Distance from nearest well__L.� _r-----Distance from foundation.__ ____ Distance to nearest I-ne.�----.- �' Length of each line `'-��-------_Width of trench , I C. NL911- umber of Imes_:_______ . g • Type of filter material---, ---____--Depth of filter material__1�-- Total length_____---=.�'�--� 1Aorn C : Diameter-_ Dis#enc to nearest lot Seepage Pit: Number of near elf_,�Lining �D#e aal--A C f founds_.Size: � t3� Depth 2`� 0 IJ p I Cesspool: Distance from nearest well_________________Distance from foundation_______________-_-.Lining material___________________.______-_______-_. --Di an --------------- --------Liquid Capacity---------------------------gals. Size: Diameter------ ----------- --------------- p � �� Distance from nearest well__----__.._-------------------- Distance from nearest building____.___________---------- Privy: + ❑ Distance to nearest lot line---- --------------------------------------- --------------------------------------------------------------- ---------• --------- -------� . aw ----- ------------------ Remodeling and/or repairing [desc�ibe :__ _- ----------------------------_---- - --- ------------------- ------ --- -- --------------=--------------------------------- ------ ------------____------------------------------------------------_ - V 1_ I hereby certify that 1 have prepared this applicatiotyand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the an Joa uin Local Health District. r (Owner and/or Contractor] (Signed} ------ Ow ----------------------•-------------------- --------- --•-- --------- ---- ------------•--------------- - (Title} - --------------------- By:------ buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in.relation to wells, FOR DEPARTMENT USE ONLY ) DATE-------- c� � - ---------------- � APPL1CATlON ACCEPTED BY----------------------------------- DATE------------------------------------------------------------ , iREVIEWED BY-------------------------------------------------------------------------------------------------- ------ DATE BUILDING PERMIT ISSUED ----- Alterations d/or recommendations ___ _______________ 4 �'- c ----ate --------- ----•-------- •--------------•--------------------------------------- ---- ----- --------------------- - ------- --- --- - d�� ------------ ----- _4? N Date--------�----- : FINAL INSPECTION BY-------------- -- ------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Magellan Ave. 300 West Oak Street 124 Sycamore Street 205 West 911%Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVI3EP B-59 3M 3-'63 F.P.CC.