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FOR OFFICE USE: ------ ----------------------- - ----------- ------------------- kAPPLICATION FOR SANITATION PERMIT Permit No. .. ...... ........ -- -------------"----------- --------------------- (Complete in DuplicaFe) .. - Date Issued __--- - --------------_..__ This Permit Expires 1 Year From Date Issued 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 with County.Ordinance No. 549. i JOBtADDRESS AN LOCATION__5- L � - " '-----------------------------------••------------------------------- Phone I Owners Name-------- � • -•-'- ------•------- ------- - q� - -------------- Address --�- �� .��=�= -- .�----- ------ - Contractor's Name------- •---------_ Phone.___••--•---------•----•----------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 'El /Trailer Court Motel ❑. Other ❑ r - Number of living units: _...1_-- Number of bedrooms'_____.'"-umber of baths -----[- Lot size ___._-. w4/ _ -_-.- J--- -- ----=--------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Ta I _ ft� �--- it Sandy Loam Clay E] Adobe[] Hardpan El Character t- Character of soil to a depth of 3 feet: Sand ❑ GraGel ❑ Sandy Loam Clay Loam Clay E] Adobe❑ Hardpan El Previous Application Made: (If yes,date--------------------I"'No\jn New Construction; YesA�' No Elf-FHA/VA: Yes ❑ "No TYPE OF.INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.).' _ Septi Tank: Distance from nearest well-_ -. _ ----__Distance from foundation, C --_...Material_ : ------ Capacity.., '3__Y_ X�J_ Li uid de th--------- - - - - -- -Ca acit No. of compartments -�� f� Size f. 9 p. y P Y-•• �� ---..__ .Distance to rest lot Ii __ tce _ -'f a Width trench_ Dispo Fiel Distance fr crest well____ ante from oundat'� t Number lines'..'. '- ----Len h of each lin --. Type' filter mater I__ _ -7�' of filter aterial------ ___ _�---.-Tot length--------- -------------------- ---- " m is ee to ne re t li e----------------- Seepage:Pitceest II_ _ ___ +stanc • -------- . � .,-❑ Number of pits-------------------- Lining materia------------- ----- Ize: D' me er.---- -------�.- Cesspool: Distance from nearest well--------__--_-_-Distance from foundation--------------------Lining material_---..----_--___--.---__-_---_-_..._ ❑ Size: Diameter Depth Liquid Capacity gals --� Privy: Distance from nearest well__.._. _____ Distance from nearest building.__._ 0 Distance to nearest lot line--------------------------------- d / Remodeling and/or repairing (describe):-'__------ -- _ _ - ------- ----- Y Yf I hereb certif Y that I h_a_v__e____p__repared 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. —� -------------------------------------- (Signed) l ._(Owner and/or Contractor) (Signed)---------- �_ _: -------- - --- ------ ----------------------- L r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----------------------------------------- DATE---------- --------- ----------- REVIEWED BY------------- - - - DATE_ /� ;r BUILDING PERMIT ISSUED .g DATE------------------------------------ eratt s nd r comm_ ns:------------ - ------- ---•- zFe - or `' y f - :Date.FINA INSPECTION BY:.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £5 9 REVISED 6-59 3M 3-'63 i.P.CD. M