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OR OFFICE U Permit No. _.L. 1. .3_U J °._...-._... � APPLICATION FOR *SANITATION PERMIT - -------------------------- -- -------------- (Complete in Duplicate)---- ---- - Date Issued =------••-•----r�..-�--- iM 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 es ri ed. This application is made in compliance with County Ordinance No. 549. ... ..l ----JOB ADDRESS AND OCATION------�-� --�---•- ------...... ---- Owners Name- . - Address---- ------------------------------------•--•-------------------------•---•-------------------•----------• --------•---•---•---------------•----• •-•--- lj Phone -----------------------------------------------•--Contractor's Name.. r? - ' _ Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1 Number of bedrooms __- Number of baths __`:___ Lot size ..pp._��______�........................................•.. Water Supply: Public system Community system ❑ Private W Depth to Water Table .--f-�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 00 Hardpan ❑ Previous Application Made: (If yes,date------------........) No New Construction: Yes ❑ No ❑ FHA/VA. Yes ❑ No } TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well---6D---•-Distan fro foundation__�� ---------Mat ri�l._�� ......................d`��. Nc. of compartments--------.- --------- ._Size- -� -Liquid dei?tfl-------�-------------Capacity-------- I Disposal Field: Distance from nearest welL�0..._Distance from foundation---- Distance____________Distance to nearest t 1!'"r Number of lines.............. Length of each line------_L _-- - ..._.Width of trench...... of filter material.�.C�1�Depth of filter material ____ ___________Total length_.....::--La.n-_______......__.. Seepage Pit: Distance aneetIo. nearest well_______-..__________Distance from foundation-----------_......._Distance to nearest lot line................. El �bAof pits----------------------Lining material-----------------------Size: Diameter----------------.------Depth..............-------.-----. --- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material...............-_. ---...______-_.__ ❑ Size: Diameter.----- ------Depth--------------------------------------------------Liquid Capacity..------------------------..gals. Privy: Distance from nearest well_______________________________y___.__---_..-_-Distance from nearest building............._______-_------.-______...... ❑ o nearest loft line------------------------------------------------- =---------•-•-----•-•--------•---------------•------ ---------_.------------ Remodeling and/or repairing' (describe= -fir C= u'"� .......t-A...... .... Q r - ilI l _. ----- ----------•----------------------------•--------------•••---...---------•---------------------•---....----------------=--------------------------------------------- r -----------i---------------------------------------------------•i--------•--------------------------..-----------_--------- '--•-•-••--------------------------------- ------ I 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 rul s and egulations of the San Joaquin LocA Health District.--" it f � ?.l. ------- ----------------- By: ----i....----------------------------- -------�`- --------- ( weer nd/or Contractor) (Signed).-------- -- �1 - -- - - - ----------------------- --•--------- ------• ---- Title ------------------ ------ ........ sr• ) i (Plot plan, showing sire of 10t, location of system in relation to.welis, buildings,�etc., can be placed an reverse side). �I FOR DEP RTMNT USE`ONLY ;_• �• APPLICATION ACCEPTED BY ~y 1 =` •-------"'----- - " FDATE ----------- I - REVIEWED BY '" DATE l BUILDING PERMIT iSSUED-2-------------------------------------------------1-------_J----------- ---—DATE •- 3 Alterationsand/or recommenIIdations----------------------- -- -------------------- ---=-4-----=-------------•----------------..._...._.....-------------------------------------•••----•------ -------------------------------------------------il_._...-.---•------------------------------ -------------------------- -----=--------------.._.....-------------------------•--•-------------------------------------------- i ------------------------ ---- •-----------••-•------------------------•------------...---•------....------------- -----•-----------. ill i M -----------------------•------------------------------------•--•--....... = Date------ --- Ll .�. .` FINAL INSPECTION BY ------ ----- - -------- ` SAN JOAQUIN LOCAL HEALTH`DISTRICT t ' 130 South American Street I� 300 West Oak Street ` 124 Sycamore Street 205 West 9th Strut Stockton,California ;I Lodi,California Manteca,California Tracy,California ES 9 REVISED 10•59 pM 9-5t Ar LAB