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nl � APPLICATION FOR SANITATION PERMIT Permit No. ____. r {Complete in Duplicate} `- U�S. *-* - __ -,—. -A — -n _-_ - - . .. Date Issued Application is hereby made to the San Joaquin Local Healtli District for a permit toZonstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. `f ------------------------------------------------------------- JOB ADDRESS AN CATION__ ___ Owner's Name--------- f � �-�-- �fp h.G=--------------------------- - ... Phone-------------------------- Address----------- l"�0--_"?,-•----� -- - - z # - r ----------=-----------•------------•---...;.....-•------ Contractor's Name------------------ - ----------- ------------- ----------��-------•----•------•--•---•-----• ----------.------------ Phone------.-------•-----------`- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Gourtr Motel ❑ Other ❑ i f P Number of living units: _,_._Number of bedrooms Number of baths .caz_: Lot size :""_ ----------""___"__"_ Water Supply: Public smysteCommunity system(:❑ frivate ❑'.Depth to Water-Table. _ __ ft Character of soil to a depth of 3 feet: Sand ❑ Gravel E]' Loam ❑ Clay Loam ❑ Clay ❑- P.do601 `Hardpan ❑ Previous Application Made: Yes {] N 'New Construction: Yes Q/ No FHA/VA:�Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer lis available within 200 feed} :. . . E�� Z Septi Tank: Distance from iealest,well"'`_.._._:Distance-fro oundation_��r__.___Matercal�r____ . __ No.. of�compartments.__.�--- -----------SiZe_17A � Liquid depth-----Z----.__ -----_Capacity.... .. Disposal Field: 6istNumabee of line's --------Disfance from founds ion_"_� _ Distance to nearest lot line . 'Length' of each line7 '* " Width of trench___ Type of filter matenal------�Y -Depth of filter material--- - Total. len th---- C - / w�� ':Distance`to nearest lot line' __CS�r f 9 � . " S �ei _ pisfance tol�nearest well--. _Distance f u ation__-.:x _ d Number of;pits--,-.v--------------Lining material-_� e: Diameter_._..�i��_--- -,-.Depth-.---sem. ---------------------- f "- `E Cesspool- Distance from nearest well__: __-_:Di ance fro foundation-------------------.Lining material----------_---------------- ___._._... V ❑ xize: Diameter Depth '------ ------------- Liquid Capacity - gals. `y Privy: Distance from. nearest well--',- ._._Distance from nearest building.___..-."-- ❑:- �. n.Distance'to'nearest-lot,line - .___�� _ ,� ._. - - ----- ---_-------.` - ---- ------ -- _ ' '. - Re odeiin and orre airin describe}: __- "- __ -" �_�_� ________ IP -------"-------------------=---- ---------------------------------- ------------ -------------------------------------------------- ----- �. mL ,. u -------- r - ---------- i r - --------=`---•--------------- ----- ------------------------------------------- 7- +f •-•------------------------------------`--------------------------- -----`-------------------------------------------------------------------------- -----•---------------------------------------•---------`----------------------------•- 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. _ - - i � , - a ----------------------- -----------------------------------------(Owner and/or 0n actor)(Signed) F x (Plot plan, showing size of lot; location of system in.relationio wells,'buildings, etc:, can be-placed'on reverse side]. s a yp, _ ,.! _1 , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ----- ----- -- ----------- =----. - DATEY- --------------- "---------------------- BUILDING �- BU LDNG PERMIT ISSUED----------------- D -� '--E -------------- -------- ------------------------------ ------- --------•--•-"------ --- -------• -----:--; ---------------------------------•--- Alterations and/or re�commen-dations:-I � t - i # -- ------------------ - ------------------------------------------ou _ ----- o F I -., - -_ ----------'------------------------------------------------------------------------------------_- --------------------------------------------- ---------- - ------------------------ -----•-------------------------- --•----------"------ ------"-•------------------------------------•--•-------• -- - ------ =-----•---- - _------------------------------. - ----..---.-.-..- . lip ------------- --------- ------- ------ ----------------•---- = ----- ---- ------------------------------------ -- 3 FINAL INSPECTION BY:' . :�'_ = Z _` `_ _ Date "��'-js - - I SAN JOAQUIN (LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C'! Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M , Revised 1-57 F,P.CO. t f