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FO/OF -I C I-USE: II lkall� ' ;�, --_ ' -------------------- APPLICATION F611 SANITATION PERMIT --------------------- Permit N6- ----------------J------ ---------------- -------- --------------- <3 (Complete in Duplicate) Date Issued ----51; � ------------------------------------------ ------ -- This Permit Expires I Year From Date Issued Application is hereby 'Made to the San Joaquin Local Health District for 6 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- - '� a -AOwner's Name----'-,---- " ------ ----------- Phone----••.....................•-------- Address------------------------ ------------ Contractor's Name----------I Z -- ------------------------------------------------------------------------------ Phone..------ --------------- -- Apartment Installation will serve: Residence aent House ❑ Commercjalt[] Trailer Court 0 Motel E] Other ❑ Number of living - --------------------- -7 units: ------ umber of.bedrooms Number of baths size --------7,�__ Water Supply: Public system ��mmunity system [] Private 'E7]' Depth to Water Tablet<-7ff. Character of soil to a depth of 3 feet: Sand E] Gravel E] San oa.m El" Clay Loam ❑ Clay I❑ obe a-_Hardpan 0 Previous Application Made: (If yes`,dote----------- New Construction: Yes,E] No-[�T� PHA/VA. Yes 0 No---------) No uctiGn. TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or-cesspool permitted-if-public-sewer is available within,'200-feet:-.) Septic Tank. Distance from nearest well---------------�_Distance-from-foLinclation------------- Material--------------------------- ---------------------- 171 N8.,of compartments--------------- -- Size.--f----,-.--`- --"--Liquid clepjh------------------------ Capacity------ - •' -- ---- Disposal apacity----------------------- D;sposal Field: Distance from nearest well.................'.Distance fio`m18undafion--------------------Distance to nearest lot line---- -------- El Number of lines----------------------------------!.-Lengfk of each.line-_`-------------------------..Width of french---------------•------------------- .POW _—Type of filter material---------- -----------Depth of filter mliter.ial'�-..------------------Total length__________________________________________- 0 ge)�tr w ------------------------ Distanq__�om_foun nearest lot line_______ Seepa Distance to nearest 'ell-' d�,f �3Number of pits-.1----- -----------Lining -----Size: Diamefer-,-3- ---Dept QZ--- Cesspool: Distance from nearest Size: Diameter- well---------------�_,_Distance fr- _. _.:__.Lining Jounclation-------------- ......Lining material---- --------------------- k.-- El ---- :.Depth---------- ------------------- ......__...--------Liquid Capacity-,-------------------------gals. Privy: Distance_f ro rn_n e a rest-we I I-------------------- ----------------- ----------Distances nearest building,----------------------------- ........... ❑ Distance t6 nearest lot line-------- ----- ------------------------------- ------ ----------------- --------------------------T---------------------------------- Remodeling and/or repairing (describe):---------------------- ----- -------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ --------- ----------------------- -------------------------------------------------------------- ------------------------------------ ------ ----------------------------------I----------_------------------------------------------------------------------- -------------------------------------------------------------i L----------------------------- ----------------_------------- ----------------------- --------------------------------------------------------------- - 1 hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, Sfa laws and u and regulations of-the San Joaquin Local Health District. ---- -------- ---------------------------------- (Signe IV - ___ ---------------------------------- ------------- -.(Owner and/or Contractor) By:------------------------- --------------------- - -------------------------------------------------------- ........... -'---------- (Plot plan, showing size t, locatiio'n olf�sysfem in re ation to wells, buildings, etc.,.can be placed on reverse side). �ern in FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_I--_-------'----- ------T ---------------------r--------------------------- DATE__ �` -------------------- -------------------- REVIEWED ATE----------- REVIEWEDBY-------------------------- -------------------------- ---------------------------------------------------------- DATE-------------------------------- BUILDING PERMIT ISSUED--------------- -------- --------------_ ----------------------------------------------------- DA-TE_-_____._____, Alterations and/or recommendations _________________- --------- - --- ---- ---------ev;�7-------I------------------------ ------------------------ -- -- ---------------------- --- -------------------------------------- ----------------------------- I< A..........�t�e,c-------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------- -------------------------------------------------------------------------------- --------------- -------- --- ---- -- ------ ------------------------------------------------------- FINAL INSPECTION BY:..---- ---------------------- ----------- Date---- -Z............... SAN JOAQUIN LOCAL HEALTH DISTRICT ve: \& 0 Street 205 West 9th Street 1�0,11 E.Haxelton'A 00 West Oak 124 Syc more roe Stockton,California Locli,Cc ornia Man4ca,California Tracy,California FS 9 REVISED B-59 3M 3-*63 F.F.CLI.