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---------------------------------------------------- /4 r-a AI,�CATION FOR SANITATION PERS Permit No. .................... . --------------------------- ---------------------------- (Complete in Duplicated -_--_.--- 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. This application is made in compliance.with County Ordinance No. 549. JOB ADDRESS A LOCATION - ---f�`= u: ' fir ----------- .. Owner's Na --• - ----------------------- -------------------------- Phone---------------------.............. ,/ e- ---- --------- A ---------- ------ ' ------ --- -;j :Address - - . . _C�'C .-----------._.-- Phone---------......................... 16.m Contractor's Name . .` Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other El Number of living units: _1_--_ Number of bedrooms _- Number of baths _Y.. Lot size -----------------------I �* Water Supply: Public system ❑ Community system ❑ Private WZDepth to Water Table -------- ft. i 3 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑' Previous Application Made: (If yes,date---------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑, lIr TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �.. Se tsc ank:. Distance from nearest well_A - -_--..Distance from foundation-----J.P--------.Material_._4`tC f_� .--__----.-_._.___.. f/ No. of compartments--------77-------------Size `l�__X_-- ,X_* F.Liquid depth_____q-------------------Capacity.l. c'- {_! Disposa field: Distance from nearest well---- --_Distance from foundation....,1-6--- ------Distance to nearest lot Iine.S............. __Length of each line_ -----------------Width of french----__-... .................. Number of lines______.__---_._ alQ _ Type'of filter material_ _� Depth of filter material__.._ _~_______Total length______l '________________________ ------- Seepa Pit: Distance to nearest well-------/_C1l)------Distance from foundation----/9-_--____.Distance to nearest lot line-_-- .5-------- ----- Number of pitsr-r::_-__--_Lining material/1- '-----Size: Diameter------ - - -�----Depth---- -5----------- La --_.._.. Cesspool:. Distance from nearest well--------------- Distance from foundation--------------------Lining material--.------_-__--__---..--_--_____.__. ❑ Size: Diameter--------------:_-,. •------:IDepth----------------------------------------------------Liquid Capacity---------------------------.gals, p Privy: Distance from nearest well---------------I------________ e from nearest building_-_-------___-----_--__-____--_---------. _ -------------------Distance Distance to nearest lot line t-------------------- ------------------ Remodelingand/or repairing (describe :----------- - -------------------------------------------•--------------•-•-----------••--------------------------•---•---------------------------- v ---------------------------------------------------- ----------------------------------- ---------------------------------------------------------------------------•------- ----------------•----•----------------------------•------------------------------------------------------------------------•-------- ------------------------------------ --------------------------------------- -------------------------------------- ---------------------------------------------------------•------------------------- t4.r 1 hereby certify that I have prepared this;application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations?of the San Joa vp Local Health District. q, Signed) �I � �� -------------------=- t�3Wee1 and or Contractor 60 By:--------------- ------- -- - - . tL s'`--,,------------------------------------------(Title)------------------------------------------------- -------------- (Plot plan, showing size of lot, location of systefn in rel" ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... --------------------------------------------- DATE.../_' _ -A REVIEWEDBY-------------------------------------------------------------------------------------•--------------------------------------- DATE----------------- ------------------------------------------ ''' BUILDING PERMIT ISSUED----------------------------------------------------------------------=----------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------- --------------------------------------------1----------------------------------------- ----------------------------------•---------------------------- 4 ---------------------------------------------------------------------------------------------------------------------------------------------T.-__�_f_ti-------------------- .-------- .----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ LA r FINAL INSPECTION BY:,I - - --------------------- Date----- ~Ae-!'"�--'Z------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California 6,t ES 9 REVISED 8-59 3M 3-'63 F-P.Oa.