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FOR OFFICE USE: ----------------_---_ APPLICATIOIFOR SANITATION PERMIT Permit No. ... ... - --------------------------------- / ------------------------------ -- ----------------------- (Complete in Duplicate). pate issued g ---._________________________________________.___.. ._ This Permit Expires 1 Year From Date Issued I ( P6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 2 This application is made in compliance'with County Ordinance No. 549. r JOB ADDRESS AND LOCATION. _ . /f/---- ----------•-----------------•- ------------------------------------------•-•--•------------------------------ Owner's Name-ll -------- n _ phone-=-------------•-----------•-------- pp - - = # Address-------- } `- ------------ -•---------------------------------------------------------------------------------------------------------------------•- ----•----------- ----------------- Contractor's Name__C '_..3-I_J-----------•--•------------------------------------------------------------------------------------ Phone.....--- - - --------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,C___ Number-of.bedrooms ____ Number of baths I______ Lot size _ja-Qx�C_0?_____________________________________ Water Supply: Public system [�Commuriifiy system ❑ private ❑ Depth to Water Table _. ®ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C3 t Previous Application Made: (If yes,date-------------------I No CJ New Construction: Yes No M�FiANA: Yes ❑ No ®-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is„Tan Distance from nearest well_________________Distance from foundation----_________'_____-Material-_____. _____._________..______----- _____.___. No. of compartments------...-_--------------Size---------------------------- ---Liquid depth-..-------- -- - ---- ----Capacity------------------------ s sal Fi�l Distance from nearest well...-' __.__._Distance from foundation. V. _________:Distance to nearest_ot line--_`-_�-_--- � // Number of lines._= --:�--------------- -- Length of each line----,�.7 -`--------------.Width of trench--- 1 `.--__-___--_---_-- t� Len f� Type.of.filter material_��1G�_____._Depth of filter rrsaterial_,l_8'`__________Total 1�;ngth________�d.:'�____________ e Seepag�Pit: Distance to nearest well 1_____ Distance from foundation-- d_--____-_..Distance to nearest lot line___6�._-.- [� Number of pits------t--------------Lining materiae-G _-----Size: Diameter.---.!� .3_ .......Depth--.-- -i5----------------- r,(� Cesspool: Distance from nearest well-----------_-----Distance from foundation---------------------Lining material__._.___________.__._-___-_-_--.-.-. ❑ Size: Diameter------I--------------------------------Depth------°---------------------------------------------Liquid Capacity----------------------------gals. t Privy: Distance from nearest well--- ------------------------------------------ Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line.-------------------------------------------F------------------------ ----------------------------------------------------------------- - ; Remodeling and/or repairing (describ!e):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------•------------------------- -------------------------------------------------------------------------------------- ---------------------------••----------------------------------------. --------------------------------------=------------------------------------------------•------------•------•--------------------------------.._... ...-------------------------------•---•-•---------------------------- ------- --------------------------------------------------------------------------------------•----------------------------------------------------------------------- ------------------- ----------------------- hereby certify that I have prepared this licatio and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and Iregulation of th /SanJoquin Local Health District. $i ned ,. _(Owner and/or Contractor) By:---------------------•------------------ ----- ------------{Title)_----------------- -----------•------- ------- - ---------- (Plot plan, showing size of.lot, location of sy tem in relafills, buildings, etc., can be placed on reverse side). ” FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------�---t_�-�----=-------------------------------------------------------- DATE--- Q = -------------------- REVIEWEDBY-------------------------------------------- ------ DATE------ -------------------------------- -------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or commendations- -- --- -- --------------------------- -----------•-•-•---•--••------------_----------.-..-------------------.--.-- ----•--------------------------- = --------------- -'------=--------------------------------------•----------------------------------------------- ---------- I --------------------------------------------------------------------- ---------------- ------------- ----...-------------- --•-- ---------- ------- -------------------------------•------------------------------------------------_--1----------------------------------------------- F1NAt INSPECTION BY:.--,,,' � s-------------- Date r -- -------------------- -- ------_-- � 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 FS 9 REVISED B-59 3M 3-'63 F.R.CO.