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rvlc vrrit,t u6t: —— -------------------- --------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- -_ --- ---- --- (Complete in Duplicate) -- --- -- ---- ------ - _ This Permit Ex ires I Year From Date Issued Date issued 1-47A- Application is hereby made to the San Joaquin Local Health District for a permit to constructeved. This application is made in compliance wit County Ordinance No. 549. and.instali the herein dscr JOB ADDRESS A LOCA O Owner's Name-"_"_-- --•��---��- -----------�---P----o,-a------- -------- I/elf Phone - Address ----------------- ------ - _---_--. Contractor's Name_-- " %74 -- Installation will serve: _Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other Number of living units: " ""_ Number of bedrooms� j E] # _-- Number of baths Lot size " ""y / ---------- --•--- -- Water Supply: Public ❑ .Community system ❑ Private Repth toWater Table -<494. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe Ll Hardpan ❑ Previous Application Made: Of yes,-dgte__.."_ -----------] No New Construction; Yes TYPE'OF INSTALLATION AND SPECIFICATIONS: (No E] FHA/VA: Yes ❑ No�- (No septic +ank,or cesspool permitted if publi,sewer is available within 200 feet.) Septic Tank: Distance from nearest well_,AJO---Distance from foundation""/� �_ Material-" _ _ o� No. of compartments-,1 ----------------Size44-_xW- ""-Li uid.de th-_0j. " I q P. y Capacity- Q Disposal Feld: Distance from neares# well _„f- _.="Distance of each fine foundation .,�Q"" �- ---__Distance to nearest lot line-_�------- �/ Number of lines"' _"""" T idth of trench-A ype of filter me#eriaLil�Depth of filter material-- -----------Total length--- -----=------------------------ G i Seepage Pit: Distance to nearest welf__fl _�__Distance fr m fo ndation_, � (, y ___._-_-.Distance to nearest lot line-_ta'�- """"_ (� Number of pits _'*-,f_"""--,""___Lining mafierial"- - "Q�/C - ii •, -Size: Diameter-J7,,' - Depth"- oJ -------- .� Cesspool: Distance from nearest weft-__-----"--_----Distance from foundation--------------------Lining material"-__-".-. _- -------------- Size: Diameter- ---�--------------------------------Depfih----------- ------ - Liquid CapacitY----------------------------gals. Privy: Distance from_nearest well--__----"----_"_--------------------------------- Distance from .nearest building.------------------------------- Distance --------- ❑ to nearest lot line .......... ".__ - - ----------------------------- ------------------ Remodeling and/or r pairing (descril�ej:- i --' ----- ------ --------- -------------- •------------------------ ----------- --------------------------------------•-------------- ---------------- --------------------------•- 1 " ----- -- --- -----------------------------------------------------------------------------•------------------------------------------ ---------------------------------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyr . ordinances, State laws, and rules and'regu ations of the San Joaquin Local Health District, ti (Signed)------------ r - -----�/or Contractor r 8Y� --------------•----------------------------------- Title_ ) (Plot plan, showing size of lot, location of system i . r ion to wells,.buildings, etc.,.can 6e placed on reverse side). FOR DEPARTMENT USE ONLY . DATE- ---------------------------- S BATE-----------/ J - --- ----------------------------------------- REVIEWED BY -i, - •------------ DATE BUILDING PERMIT ISSUED. APPLICATION ACCEPTED BY........... -------- --- .-------- ---------- -------------------- DATE erations and/or recommendations � -------•----•----•- Alt -- ------"- --•--------------------- ----------------------- - -------------------------- -•-------------------------------- ----------------•--------------- •--------------- ------- ------------ -------------------- -----•---------------------- ------- ---------------- ------------- FINAL INSPECTION BY:--,-- Y'SAN Date----- - I .----- - ------- ---- ---------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street � Stockton,California Lodi,California Manteca,California f5 9 REVISED 5-59 3Tracy,California M 3•'63 F. Y