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FOR OFFICE US`E. " ------------- - -------- - i'" ``- ________ _ _ _______ ._. APPLICATION FOR SANITATION PERMIT Permit No. .4 r2- - ---- - - - - ------------ --------------------------------------------- (Complete in Duplicate", ,This Perm •, t it Ex ires 1 Year From Date Issued Date'ls�aed _la-/ �/p 3 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 Qrdinan No. 549 JOB ADDRESS AND LOCATION__ , 1 tZ' .P "y '.. Owner's Name '_ 1� ------•-----------—- / Phone------------------------------------ Address - Address---- � Contractor's Name--------•*- It-------—----�- -5' - -------------------------------------- •-•------ Phone------°-•----------------...__._-- Installation will serve: Residence W---Apertrnent Ho se=❑ Commercial ❑ -Trailer Court ❑ Motel :El Other ❑ Number of livingunits: __..�__ Nurrlber of bedrooms ,_,( ___ ___ Number'.of.baths _r7 4 F f --- Lot size -----1 f�0 A'!dD---�----------------------------- Water Supply: Public system '®Community system ❑ Private ❑ ',.Depth to Water Table ._-0--_ ft. t Character of soil to a depth of 3 feet: Sand �Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ }Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date....................I No New Construction: Yes �o ❑ FHA/VA`: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _" m (No septic tank or cesspool permitted if public sewer is available w1tlkin-200-feet:} Septic Tek: Distance from nearest well ---.____-._Distance from foundation7ik--------------=_.Material No of compartm7ents.-----�,----------- - -- q-------Liquid depth -_q - 1Capacity-------------- --- Disposal Field: Distance from nearest well...__ -------Distanca from foundation---,�a__ .......Distance to nearest lot line- .____-- Number of lines___2---._.----------------------- Length of each line---$``'-------------------Width of trench __''_---------:----____-- T e.of,filter material_ p:+�,fCof filter-mate_real__/T...............Total length_1;14___x_:_______________ _ YPDepth Dist to Seepage Pit: Number of pits rest well.-_---Lining material_______________________Size: D-ssameter-------------------- Dearest lot line----------------- D .__-_ ____.._ ______._ _-Distance from foundation_............. ..Distance to n 1 Pt k t . Cesspool: Distance from nearest well-----------------Distance from foundation----------------._..Lining material_.__..._____.._ � ❑ Size: Diameter-- "---•-- -------------- ---------Depth--------- - ----------------- ---------------------Liquid Capacity----------------------------gals. I t Privy: Distance from nearest well----------------------------___._______________Distance from nearest bOclin [❑ Distance to nearest lot line__________________ i ; --------------------------- 7 Remodeling. and/or repairing (describe):_I-------------------------------------- _ j --•--•------------••------------ ----------------' ----------- -1 - ------=-----------------------•-----------=--------------------------------------------- - ------------------ i F, _ :. ----------------------------------------- -�� --------•-------------- --------_--"__ -------------------- -I'/ -:-'-------------------- -------------+------..._ I hereby certify that I' have preparecNhis application and that the work will be done in accordance with San Joaquin County ordinances, .State lawe,.and rules and regulations of the San Joaquin Local Health District. r (Signed) `-� 9 " = --------------------------------------------------------------------------------------(Owner and/or Contractor) ! BY -------------------••- ------- --------------- ------------------------.------------------------------------------(Title"--- - ---- ----- [Pio+ plan, showing size of lot, location of syst in relation to wells buildtngs,`etc., can be placed o on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY- ----•--'------ -------- - -- ------------ REVIEWED BY - ---------------------------- -------------------- -- - '= DATE-"_..:__.__- = BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------=---------- DATE------------------------------ Alterations and/or recommendations:-,'----------------•----- ------------------•--- ------------- ---------•----•--- ---------•--------------- -----•-•--------- --- • _ - -------- - --- ---- r Date__... -- FINAL INSPEC B --- �7 ��/ /:�� -- --------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California �� 'Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 9M 3-'63rF.P.120.