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1`01 OFFICE USE: .: ....... ....................3.;- ..... APPLICATION 'FOR-$ANITATION PERMIT Permit No. .. f` (Complete in Duplicate) ._._..!_............... ..._:.......................... This Permit Expires 1 Year-From Date Issued Date Issued Application is hereby made to the San Joaquin Local 'Health District for a permit to construct and install the work herein described. �• aa This application is made in compliance with County Ordinance No. 549. 14F,42^-): 2,0 7_ oe-&-Oy X 4- JOB ADDRESS AND,L/OCATION.. ytti_.1ta.>> .l��e + J +t...4. __4. 1.LP!L.. ` 'd" .. Cd�! t� . .............�.___._..'. Owner's Name._.:__._._. ..... �J - !C1izr4- �f... -... ::._........ Phone............................ Address................10AAQ B /_�20.K ........ - ----✓-------------------------------- ----------------------------------------------------------------------• --..---------- rfl-Contractor's Name....... .............. .. - ._... .... ... '„ C •..__...... t Installation will serve: 'Residence Apartment House ❑ Comme al ❑. Trailer Court ❑ Motel ❑ Other ❑ Number of living units:..:_F!._ Number of bedrooms __- Number of baths _------- Lot size ....... . .. . ..... ............................... t ! Wafer Supply: Public tsystem.❑ Community system ❑ Private (Depth to Water Table _QQ_ ft. Character of soil to a depth of 3 feet: `Send ❑ .Grave! C?/S dy Loam ❑ Clay Loam E] Clay E] Adobe E] Hard pan F]Previous Application Made: (If yes,date........ ............I No [+ New Construction: Yes N No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank'or cesspool permitted if'public sewer is available within 200 feet.) C � Septic Tpnk: Distance from nearest well.€_ .1----- stn fr ation.----- __Material-----5 _____________ -----/ No. of compartments....... -.... a - ___Liquid de th_....�.--._ --------Capacity...1>� Disposa field: Distance from nearest well--...J__-..�._Distance from oundation..... .Q.__.......Distance to nearest lot line._ Number of lines._.._ •____.. .1.__._. ----Length of each line---.___-��.....��.........Width of•trench....._�_._3-[.t--------------------- material- of filter material_:_ �S+�Uepth of-filter material..._.f��_.......____Total length___.._....��._Q:.................. ..... See a Pit: Distance to nearest well..---- --------Distance from f undation.... Q_..-f'---.Distanc� to nearest lot li�e_.."`� PJ ` Number of pits..--_-:..t..........Lining material._. ,.4�'i&----Size: �Fer--4_XQ.Q_.._-•--Dept h......I1-----------------------�� Cesspool: Distance from nearest well_.._-- ...._.Distance from foundation.............:•------Lining material--------------------------------------I � ❑ Size: Diameter--- --- -•---:----``bepth----------------:-----------_.--------. ---.--------Liquid Capacity------------------------ gals.-%. Privy: Distance from nearest well................___-:_.-----._..._____..._._Distance from nearest.building.......................................... 9 ❑ Distance to nearest lot line...:...-.(..........'k...........-----------------------------------------.................................................................... Remodeling and/or repairing (describe):... ................................................................................................................----........_..........•-----...------ 1 --------------------------------- ••---•----------------------------------------------=------- •--------------------------.--------------•------•-------••----------•--•-------------------------•--- --U! ------------------------------------------•-----------•-------_.....------------------------•--=-•-----•-----------------------•-•--•----•--••------•--------•-----------------------•---------------------------•-------- 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 re ulations of the S Joaquin Local Health District. (Signed)----------- q t . -._(Owner and/or Contractor) _ By------------------------------------------------------------------------------------................................................(Title)........-..--_---------- (Plot plan, showing size of-lot, location of system in relation to wells, buildings, efc., can be.placed on reverse side). ��rr FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY-----------[.=.r' --•--------------- - ---------- ------- ---------------- DATE---- f---------------------- ---- REVIEWEDBY............................. . . -•-------•---••-----...----•-------------...._.. DATE_........... ..................................-.......... BUILDINGPERMIT ISSUED..................... I ••••...................._••---------•------........._•----_..__ DATE-..------_----- -------------------------------------------- Alterations and/or recommendations:.........----------------------•••---•-------------------------_-----•-------- .................................................................. ................................ .......................................................--------------------------------------------------------------------------------- ...........................-•---............... p y --•--------------- --•----------------------------------------------------- -----------------------•------ -----••-------...----....................__....------......------......-----•.... --------._...................-- FINAL INSPECTION BY:..C_,<__Q._ -< (C------------------------ Date-----.1..0 ...__: � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Strut 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [S 9 NCVIC[D 8-59 1M 3•'63 F.P.CO.