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FOR O.FFI,CE SE: - ------- "________________ KATION FOR SANITATION PERMIT Permit No. . _ _�J- (Complete in Duplicate} --------------'---- ="=--.- This Permit Expires 1 Year From Date Issued Date Issued �(f-•- 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 AQDRI SS.AND LOCA ON ------------ - --`-"�.r---------------------- r Owners Name--------- ----- f ••----------- --------------- Phone,------------------------------------ Address .-•-------••--------------•••-•-- ' Address--------•--.-�-7 ' S' r ._ ------ ° _c .-- --------"----•--- Phone..//- - ------ y -------- ---------••-------- Contractor's Name___t Installation will serve: 'Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel :❑ Other ❑ E Number of living units: --)--.- 'Number of bedrooms __,/:'_.Number of baths .._.�__ Lot size _..l_�___X_-..� - O Water Supply: Publics stem .. _ --•-------------- -----•- PP Y� Y ® Community system ❑ Private ❑ Depth to Water Table ��_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(FJ Hardpan ❑ Previous Application Made: (If yes,�date____.-_-'_-___.__._) No Z New Construction: YesNo ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet-) Septi nk: Distance from nearest well-&P 15 Distance from foundation_ - Material d t t -------__________Noofcompatments Size quid de th - - ---------Capacity----------- "�7 Disposal Field: Distance from nearest well.. � ? __. _ -Distance from foundation.__..r¢_.�__.Distance to nearest lot line------4�-.-_____ �]C Number of lines ---------------!' ----------- --Length of each line------- -- ----------- Width of trench--------:--=,�- ------------•- Type of filter material �, "¢Depth of filter material___! _��----: TotalO'length____-_.____ . T..-,.- — ...,�.. _ ------------ ��''//�N� .� Seepage Pit: Distance to nearest wel! s ____-""-_----Distance from foundation____,/c_.. .__.Distance to nearest lot fine---- [ Number of pits_._,/___-__-•-/___---Lining mafierial_: `' .Size. Diameter____ _ �` Depth--------- "----_-_ Cesspool: Distance from nearest well------------------- from foundation-------------------.Lining material__._____._--_-.._ ❑ Size: Diameter--! Depth--------------------------------•-------------------Liquid Capacity-- ---------••------ - -gals. ! Privy:r Distance from nearest well________________ ___ ____ ___" Distance from nearest building------------------------- ❑ Distance.to nearest lot line----------------` l --------------•-----------------------•-------•-------I------------ Remodeling -- - -Remodeling and/or repairing (describe):--------------------------- *'•.` _________________________________________________________•f-_ -----------_____--------------_-------------------_---------------------------------------------__ is el F __________________________________________________________•_____.________---._____._..-______---___ ------------------------------------- -= -------------------------------------------------------------------•-•------•------------------------------------------------------------------------------------------------- I hereby certify Wat'I haye'piepared this application and that the work will be done in accordance with San Joaquin .County ordinances, St a laws,'and rulesand regulat'ans of he San Joaquin Local Health District. , r a. (Signed) _ ,a -s-- . /------------:- .(Owner and/or Contrac+or) Plot len, showing size i :- {Title)-------------------- B ------------- -----•-=----- --- P i p g of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT L ONLY APPLICATION ACCEPTED BY-'-'-.---- --------- ---- - -------�` --- --------------- •�-.."l�� f REV -- DATE---- aIEWED BY----- •-------------- # ----- - DATE--------•-------.._..... ----- BUILDING PERMIT ISSUED--------------- -------------------- ------=-------------------------------• -----------....__ DATE._..----------------------------------- Alterations and/or � { recommendations:*_"____________________ ----------------------- - - --- ----- - � ---- -- --- a ---•------- -•-- •-------- -----------------•-----•---------------- ---•-""- _--•-••---- - -----------�-- --- - ------ ------ --- -- � ' _- -- FINAL INSPECTION BY-------- ----------- ----------"_--- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California s Lodi,California Manteca,California Tracy,California ] E9.9 REWECD 9-59 r. co,7M 6.60 J(J s r