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FOR OFFICE USE: F ------------ :/_ fy APPLICATION FOR SANITATION PERMIT Permit No. `- ------ ------------- ____ (Complete in Duplicate) Date Issued ._L- -----L f 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. {1. This a splication-is..made-i-c mpliance with County Ordinance No. 549. M1 �t JOB DDR SS AND O ATION / 11-_ - . � 1� -� -------- ----------- �r 1 Phone_-----------------•------------ /----_ 'z Owner's Name---------- ------------------------- - -----------------I Address------------------ --------- `� - --------------------•-------- --•----•-------------------------•----------- Contractor's Name--- ---- -- ------------------------------------------------------- --•- Installation will serve: Residence M---A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / I Number of living units: _/--.- Number of bedrooms _ __. Number of baths _-i--_ Lot size -��------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Gravel Sand Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Character of sail to a depth of 3 feet: Sand� ❑ y No El New Construction �, Yes L �'�o ❑ FHA/VA: Yes ❑ No El Previous Application Made: (if yes,date- -- ------------) : TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) / f - ---- 4D/-___Distance from foundation_----L9-------.Ma+erial_-(�-`-=.�1----- ----" Septic Tank: Distance from nearest well--____--_-- �( _I--`Liquid depth__.___.__. . , --._Capacity-�"� � Y� No. of compartments.._---..--�--------Size_ - --- ri' ---- f Disposal Feld: Distance from nearest well _ .-Distance from foundati�__ /P.- -----rDistance to nearest lot line_______..-- Number of fines-------------- ------------ --Length of each line��+a 1,C_/, .Wid+h of trench._.---- 7�.y--------------•-- De th of filter material___ -rt----------Total length---------t - 7-`-------------------- Type of filter material--- P_.- 4e_,/- p �+ I a Seepage Pit: Distance to nearest well_____._._.._.______.Distance from foundation--------------------Distance to nearest lot line- ------ ❑ Number of pits------ ---------------Lining material-- Size: Diameter -------------------.Depth-------------------------------•—s Cesspool: Distance from nearest well--------------.--Distance from foundation-------------------.Lining material-_-_---.--. gals. ❑ -Liquid Capacity------- ----------- ] [" Size: Diameter--------------------------------------Depth----------------------------------- ---------- - - Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ 6 Distance to nearest lot line------------------- ---------------------------- ------ ' I Remodeling and/or repairing (describe):---------------------- --- -----------------------------------------------------------------------------• -------------------------------------------------------------------------------.------------------------------- } p p PP th--------------------------------------------------------------------------------------- -------- - - -- -- ------- ----- - - ---------- rules and re __ i ns I her eby'tertify that I have repar this a Lica+ion and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, a g e San Joaquin Local Health District. ( r i �tv ---- -------------------------------[Owner arid/or Contractor) (Signed}'\ '► -------- , --------------- 3 (Title)---------- -------- -------------- ----------- ------------- - --- - --------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-----.- ------------------------------------ DATE /- � l '�: -- -.- --------- DATE-- - ------------------------ ------------------------------------- - REVIEWED --------- -------------- ------------ REVIEWED BY----- = - ----- --- --- -------- --- DA7E ED BUILDING PERMIT lSSU ---------------------- Alterations and/or recommen atiori ..............._...______......_ -- ------------------------------- ' ---------------------------- S Date---- - --- ---- -------------------- FINAL INSPECTION BY:--- 4 --------- rNJOAQUIN ------------- ----- ----- S LOCAL HEALTH DISTRICT t205 West 9th Street 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 'Tracy,California E5 9 REVISED 9-59 3M 3-'63 F•P.CO.