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_ t . 2- i: O---------------------•-------- --- APPLL ;TION FOR SANITATION PERMIT Permit No. ...''...n42.G........... -.... (Complete in Duplicate) r-. . Date Issued -----�................2- e --------------------------------------------- This Permit Expires 1 Year From Date Issued application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. Phis application is made in compliance with County Ordinance No. 549. F-DB ADDRESS AND;LOCATIONI�! ail -- -- -i 1 L�-• = L-= GX!- Dwner's Name {✓ �- _ti � ..4��e�'`_---=---------------✓ -•-------------•--....------. -------- ---------- Phone.................................... - �-------•-- Fddress- : " -ontractor's Name--------- � -- ---=--- ........ Phone................. .................. stallation .---•--•---•- will serve: Residence ❑ Apartment House ❑ Commercial Of Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ --- Number of bedrooms -------- Number of baths ........ Lot size --------- -------r-----=:y__`.-..-.-.. Nater Supply: Public system ❑ Community system I Private ❑ Depth to Water Table -------- ft. haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ I .'evious Application Made: (if yes,date.-.- ..--......) No ElNew Construction. Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I'>�,ptic Tank- 02istance from nearest well---_------------Distance from foundation-------------------.Material................................................. 'X4111— No. of compartments.. -- -----_............Size------ -----------------.-Liuid depth---------------- ---------Caaci ty V s osal Field: Distance from nearest well --a 6. Distance from foundation-._._f o..-.....Distance to nearest lot line...:....... ..... ... .. p ( Number of tines------------ -------- -- ----Length of each line_.....,..-CC?-- -------Width of trench..:._...1'. .................... VU ------- ' Type of filter material....n�k4 k-----Depth of filter material------ ......Total length----------- ------------1:------- eepage Pit: Distance to nearest well---------.............Distance from foundation.-..___.------•____.Distance to nearest lot line----------------- 1 ❑ Number of pits--,-.-----------------Lining material----------.------------Size: Diameter.----------.----.------Depth---------------------------------- esspool: Distance from nearest well-----------------Distance from found ... ation -----------------Lining material----------------_ .-_-----_------- I ❑ Size: Diameter--------------------------------------Depth------------------ ----Liquid Capacity gals. rrlvy: Distance from nearest well................................. ..-----_Distance from nearest building..........--.-._-.-.•_...--------....:.- ❑ Distance to nearest lot line_---------------------------------- ------ ------------=----------------•-•- -•-••---------------------•-•---------------------------- -remodeling and/or repairing (describe):.-1--------- --`- --- `:- ... .---- �-t r,t- nn •� -----------•---------------------- F_ -----------------• --•---------------------- ----------...----------------------------------------------•---------------------------------------------------------------------------------------.------------------- .. 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 rules and regulations of the San Joaquin Local Health District. '..g } --- ----- (OmneF ands r Contract �� — - -------------------------------- -----(Title)---------------------------------------------- -- ----- I lot plan, showing size of lot, location o syst Ai n relafiionfo walls, buildings, etc., can be placed an reverse side}. FOR DEPARTMENT USE ONLY `APPLICATION ACCEPTED BY ----------•----•------------------------ DATE---� 1.. .-.2------------------------------ `EVIEWED BY-_------------_-------------------------- --- •-•----•------- DATE--------------------....................................... BUILDINGPERMIT ISSUED._------------------------- -------------------------------------------------. ------------- DATE------------------------•••-------------- -------..._..------ Iterations and/or recommendations-------------- F------------- ..--•-------------------------------- ------------------------ -- J � . FINAL INSPECTION BY: ........... .... - - • ..................... _Dote.....:�� . :2. !-7---- -_--------................. FSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Syca,nore Sti**t. 205 Weil 91h Street Stockton,California Lodi,California Manleco,•Callfornia .Tracy,California 15, 9 REVISED B-59 2M 5-61 AILAS „ - -