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,FOR OFFICE USE: ---------------------------------------------------------- APPLICATION F.OR.�'SANITATION ,PERMIT Permit No. __.f__��.•�-� s '' = ---------------------------- ------------------- -------- (Complete*in Duplicate) ,"_ This Permit Ex fres 1 Year From Date Issued Date Issued .r Application is hereby made to the,San Joaquin.Local Health District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOAT ON f__37 .---- -- �- i } Owner's Name.. ----- ------------------------------------------ ------------------•------- ----------- Phone-MV..12-Z- �.- Address.................................. ! Contractor's Name................ ----------- -)f. .................................................-------------------------------------------- Phone...................................will serve: Residence/ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Othe; ❑ Number of living units: _��mmunity mber of bedrooms__ Number of baths -L_.... Lot size __--� rQ __l ............................ Water Supply: Public system system ❑ Private ❑ Depth To Water Table --._____ ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lnarri❑ 'Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No`[R� r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availabfe'within 206 feet.)'e Sedk: Distance from nearest well_________________Distance from foundation--------------------Material-------------------------..--.._.___...__._._.... No. of compartments--------------------------Size-..-----------.----------- ---Li uid de th------------- - - capacity DiT�Feld: Distance from nearest well- .�v--_--Distance from 'foundation---/Q._-_______-Distance to nearest lot lip................. !F4 Number of lines______________ _ 'Length of each line...._-_—V____ __---_•__.Width of french........ Type of filter material._ ""'' "�" ��" - r e1 ! -__-- Depth of filter material----•-��.•__--•--Total length_..--------- {-------------•--_--•- V' Seeppge Pit: Distance to nearest well----------------------Distance from foundation__________..._--__-,Distance to nearest lot line._-_.__.___-__.-- Number of pits---1-----------------Lining material---�A`-------_;Size: Diameter---------- ------Depth-----.-----------•-----•--------- 00 Cesspoo . Distance from nearest well----_--------____'Distance from foundation-------------------.Lining material-------------------------.-_.________ l ❑ Size: Diameter. ----------Depth-0 ----------- -------------------------------- Liquid Capacity----------------------------gals. I - -� -e.. Privy: Distance from nearest well___.______________________________________ _distance%,rorn nearefst building----------------------.______ ❑ Distance to nearest lot line__ _ -_------------ ---------------- Remodelingand/or repairing (describe): `+, ' - _____•_--- .L ---------------------------------------------------/ P 9 I -- •'-- ---��---------------- ------------------------------ ----------•,--,-m --------- -_-------- '------------••-----------------------------.--------. - 1 - ---- t _�'`-`-._--�--4--•._--....--••------------------••--•-----------�------ A i I hereby certify that I have prepared this application an 'tha' a work will be done in accordance with San Joaquin County�'� ordinances, State laws, an les a�d reg ions of the San Joaquinlocal Health District. Ti (Signed) = _ ------------------------------------------------- (Owner--- - -------- -- -------------:- --- - -----------�'-----•- -- -- ----- _.Owner and/or Contractor By: - ----- •--- ------------------•-----------------------------••-------(Tale)------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 r I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------4n - ---------------------------------- ------------------------ DATE--------- ------------------------ REVIEWED BY -- ------------•-------------------- DATE--------•----------- . .................. BUILDINGPERMIT ISSUED----------------------------------------------------------- ----------------------------------------- DATE Alterations and/or recommend'afion ______---- _-_------__- --------------- -------------------------------------------------------------------------------------------------------------- ----------•...........................- ------------------------------------------- ..-.... FINAL INSPECTION BY:------ -G --------------------------------------- Date........4�_�_ --------------------------- --•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lail,California Manteca,California Tracy,cantornia ES 9 REVISED 5-59 2M 5-62 ATLAS