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,--� FOR OFFICve E - �& .�� _../._/_ _.'� 4' _:m ��4PPLICATION- FOR SANITATION PERMIT - Permit No. ___....... �� . --------- ------------------ ---- -- ------------- (Complete in Duplicate) � ---- --------- ---------- ---- ' _ This Permit Expires 1 Year From Date Issued Date.Issued. ...... _4 __ 61 t. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance,wi h C un ty rdinanc�� 549. JOB ADDRESS AND LO TION..-- =- �'�'�/----------- - ------ ---- - ----G�¢ Owner's Name--------------------- ----•----•---- -------=------------------------------------------------- Phone............. ...----...... Address--_-•------------ ` = Contractor's Name_.__....--r._...____ a/��"L�C'�,�r..�----••----------------------------------------------•--•--------------.......... Phone.. - •--- •----�� Installation will serve: Residence ❑ Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ..------ Number of bedrooms ._------ Number of baths __._.... Lot size __.` - -r .............:.......... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ae ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ f Previous Application Made: (If yes,date--------------------j No ❑ New Construction: Yes ❑ No FHA/VA: Yes E] No E]TYPE 'OF INSTALLATION AND SPECIFICATIONS: . ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well.-S .......Distance from foundation--- cc No. of comportments..-..__. .............Size. . Liquid depth._.- -_.....Ca Capacity e-A��j. p 1 l �� p tY------- f Dis osaI Fi Id: Distance from nearest well__�2�...... ----D;stance from foundation.._.4............. Distance to nearest lot Number of lines-----------, -_ Length of each line---,jA_.6..-._gl__..Width of trench.._.. _ :.f".................. • fB. -. Type of filter material _ ---Depth of filter material...��-- ._.=...Total length------- Seepage,- __---- c�._�.................. See a i : Distance to nearest ell.. .-0_0.._.. Distance m vundation__ p g vj � . - ---- �r f. �_�.�-�.......Dis a/�nc��to nearest lot lin p............... Er Number of pits------- _.----.._..Lining mater.ial._. ij! .. Size: 'Diameter.___- p._-.-_-___.Depfih___. ¢------------------- Cesspool• Distance from nearest well.................Distance from foundation....----------------Lining material-.-...-....._--_-------..._...___..--. O ❑ Size: Diameter--------------------------------------Depth--------------------------- ---------------------Liuid capacity --gals. Privy: Distance from nearest-well........... ............................._-----.Di-stance from nearest building--------------------------..._--....._----. Distanceto nearest lot line-- ----------------------------------F '-----.._._.-..---•--------••--------------•--- --------------------------------- -- ------ N Remodeling and/or repairing (describe):---------------- �_ -------------------------------^---`--------------._._'-------...--------------------------------- -----------_----------- ------------------------------------------------------------------ ---------------------------- ----------`-------------•-------------------•-----,-----------------------------------------------••----------------.------- .i 7 t -------------------------------- -- --------`------------•------..-..-•--•-------------------------- --------- ---------------------------------------------------_-------------------------------------------- I -------;---------•-•----=--------------------------•-----------•------•------------------------- I hereby ceohfhat I have prepared this application and that the work will-be done+in accordance with San Joaquin County F ordinances, to la s, and'rul s and reg ions.of the San Joaquin Local lHealfh District. i ar --------- ----- ------------ (Signed)----------- - ------ ------------ - -- ----------- -----„ --------------�----- Owner and/or Contractor) BY -- - - ---- ------------------ ---------(Title}_ == x (Plot plan, showing size of lot, location of syste in relation to wel , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... �.. ------------------------ DATE------3-_-I�kr -621----- ----------- rREVIEWED BY_------------------------------------------- ----------------------------------------- •------------% ------....r DATE..---- --•---------------- BUILDING PERMIT ISSUED ---------- ------------- ------------------------------------------------------------------- DATE--------------------------------- Alterations and/or recommendations:-------------------------------------- -- -----•----------------- - � ` i - ---------------------------------------- I -------------- ------------------- -------- ---------- ---------- ---------------------- FINAL INSPECTION BY:.'_S._ = - - --- ----------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California �-. nodi,California N- Manteca,California Tracy,California Ee•9 FIEVIBED H•b9 F.P.CC :jM 6.6a