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FOR OFFICE USE: + - Permit No. _.._�_ -•--! �a -- APPLICATION FOR SANITATION PERMIT '1j/�f l --------- (Complete in Duplicate) 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. S. ,{ JOB ADDRESS AND LOCATION-.-'- Owner's OCATIO -• ` N --_ ` --------------- --------•---•------- - Phone------------------------------------ ------------ + OwnersName---- --- -• - - ------------------------------------------- --------- --------- �� , xAddress -------- �----•----- f - - Phone------ Contractor's Name--- ---------- - Installation �' .. will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms _A-. Number of baths __ -_ Lot,size .,��j�r '- -------------_----- Wa4r Supply: Public system' Community system ElPrivate �epth to Water Table _ eft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91 Hardpan ❑ Previous Application Made: {1f yes,dote__---------_--------} No New Construction: Yes ❑ No ®-'FHA/VA: Yes ❑ No 2-- 1 TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic Tank: Distance from nearest well_ ___ Distance/fom �ffo/uundation__.l1-_-.__.Mate�a�__ No. of compartments____ ________--------Size_4 _( _K--Y --___Liquid depth....!"�_-.,�-------..--Capacity___��C�__... �} r Disp�osal/Ffield: Distance from nearest weil_ ___--_.._Distance from foundation... __._.-.Distance to nearest lot Number of Fines------ ---------y-- Length of each line---� -01 � Width of trench.:----------`..--------•--------- { Type of filter material f?frt epth of filter material , ____.._ Total length :............J.________.. - Seepage Pit: Distance to nearest well_____________________Distance from foundation_____:`____._..___.Distance to nearest lot line----------------- r ❑ Number of pits------ "------------Lining material--------•--------------Size: Diameter------------------------Depth--------------------•------------ Cesspool: Distance from nearest weil_________________Distance from foundation-------------------- material_-.---_.--___-__________._.-,----_ _•. ElSize: Diameter---------------------- ---------------Depth----•----- ---------------- --------------------- Liquid. Capacity - gals. Privy: Distance from nearest we(I--------------------------------------------------Distance--from, nearest building----------------------------------------- 4 ❑ Distance to nearest lot line-------------- ___ ______ 1 � = ._ � _--•---- Remodeling and/or repairing (describe:___.__._._ __ -- ----.- - �..�� - �,��•------• s�'�------ - ------------ -------------•-------------------------- ------..._----------- ---------------- -------- ' -------------- -Z A ----- - } - r` ---- ------------- -- -••_- *' - - ___ --- ------------------------------------------------------------------------------------------ -------- 1 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 regulatigns of the San Joaquin Local Health Dis+ric+. Si ned .---(Owner and/or Contractor) (Signed) tBy:------------------••--------------------------------------------------------- F,- ------ --------:. Title (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can ba placed on 'reverse side). FOR DEPARTMENT USE ONLY' �- ! � APPLICATION ACCEPTED BY_. f '" DATE = �^ ----�� IREVIEWED BY----------------------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDING --------------- •-----------BUILDING PERMIT ISSUED------------_•--------- ------ DATE------------------------------ ---------------------- ----- Alterations and/or recommendations:____--------- -------------:77---- ` :_. ---------------•-- / -------•------ --- - f ---------------------------------- - D � r/�- l"J FINAL INSPECTION BY:. "� _- - a+e. = ` SAN JOAQUIN'LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad],California Manteca,California Tracy,California n E6-9 REVISED 9.59 r,n.00.SM 6-60