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R rUKUl-HU: U5E: ----------------------- ----------- - - -------------`- ---------- ----------------.--------- APPLICATION FOR SANITATION PERMIT Permit No. _...__/-1 f ------------------------ ------------- ---------- -------- (C�omplefe in Duplicate) / -. Ea --- ------ ------ -------------- ------------------ This Permit Ez ires I Year From Date Issued `Date Issued ---..__ Application is hereby made,to the San Joaquin Local Health Dis#rict for a permit to construct and install the work herein described. This application is made incompliance With Coun rdl a N , , JOB ADDRESS A CATIO f ----------g/------------ Owner's Name_-_ s T _ Phone Address-. - -------------------------- Contractor's Name v/`� -------------_------ Phone--------------------- Installation will serve: Residence El Apartment House E] Commercial F] Trailer Court [] Motel E] Other ElNumber of living units: - Number of bedrooms Number of bafh of size -_--"" Wafer Supply: Public system ❑ Community system ER"O"Friva#e ❑ Depth to Water Table�j'ft. E Character.of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay Adobe ar I , ❑ �dean ❑ l Previous Application Made:- (If yes,date------------- I �, � _� / ®—N ❑ - No � IVew Construction: Yes ["��No ❑ FHA VA: Yes o TYPE OF INSTALLATION AND SPECIFICATIONS: c sewer p (No septic tank or cesspool permitted if public is available within 200 feet.) r � C 1 Septic T Distance from nearest _ II--_.�_-___Distance from foundation- -"--�---_-.."-".Material_._-_-�- . a. r�. No. of compartmen#s- -------------------Size-: �Gc�_ Liquid depth___ " p Y -- iq i . _------..Ca acit - - .---- Disposal Id: Distance from nearest weil_.,-�...Distance from foundafion.;, ------------Distance to nearest lot line--�:-_---_---_ Number;of lines---------_Z_ Length of each line--�t�7,�----Width of trench-_--� ----- " f f, --------- Type of filter material-_-!_/�.__ jC4—Depth of filter material_,/��--- "-.-Total length-_-145�' 6 Seepage • . Distance to nearest we!!_�..--"--Distance from foundation__ .-_..Distance to nearest lot line.&`-_.___,_-___ Number of pits. " Lining mafierial-- _ C-_ Size: Diameter._ '/___ Dep#h__?I,5'------------------- Cesspool: ---------- r� Distance from nearest.ell-----------------Distance from foundation------ material- ----- -- ----------------- ❑ Size: Diameter---------------------------------------Depth --------------------------------Liquid Capacity ---------gals. Priv A Y Distance from neare-st well __________Distance from nearest building ;} ❑ Distance to nearest lot Ilne ---- "-----•------------------------ ----- Remodeling and/or repairing (describe):__"------------------ ----------- .......-------- ( ---------- ------------------------------------------- --•--- ------------- ----- ------- -------------------•------"-----------------------------..--------------------------------- _ _ ------- -- ------ -- ------------ - --- ----- ------ - --- ------ -- -- I hereby certify that l h prepar. -his pplication and that the`wor'-' ' k wtll be done in accordance with San Joaquin County ordinances, State laws,,an s an ons of the San-Joaquin Local)Health District. (Signed)_ r - ------------- j # - (Owner and/or Contractor) B (Ti+le(Pl )- o+ plan, showing size of lot o tion of,system i relation to ')dings, etan be aced on reverse side). --- F PARTMENT USE LY APPLICATION ACCEPTED BY.... _ :_ __- - -- D . ATE----- ------------- --i REVIEWED BY --- ---------- ------- --------------- -`-------- -------- ----- ------- DATE---- -------------------- UILDING PERMIT ISSUED - -- �"�^------ DATE- ---- - Alterations and/or recommendations:._-- -- ----------- -. --�- ----------------------------------- V = --- --- ------------------------------------------------------------------------------------- -- - .- •--------------- ------/----------- - -------•------------------------------------- --------- ----- -------------------- --- = ------- --- ---------------- --------- --- - ------=-----=----------- - FL INSPECTIO 1NA Date-- AN JOA LOCAL ALTH DISTRICT 1601 E.Hazelton Ave. 300 West O Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi,California Manteca,CaliforniaI Tracy,California ES 9 REVIS$p 8-59 3M 3-'63 F,p•pg, C �