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FOR OFFICE USE: T. _ --------------------- _..______._ APPLICATION FOR SANITATION PERMIT aPOrmit �-3.. ----------------------------------------------------- (Complete in Duplicate).: 1 J� 6 --------- --- This Permit Expires 1 Year From Date Issued Date issued --------- Application __--__/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 ADDRES ND LOCATION.-_._._._? - - - ------ - -- - Owner's Name ►' e .. . 9 ` �' -� c `T' "° Phone-------------- ---•-................ Address --------__ Ip �----------- Contractor's Name. 1 � . -•--- Phone.. _. �4 Installation will serve: Residence jJ Apartment House ❑� Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._ __�_ \Number of bedrooms of baths _1___ Lot size ___-_-`--./•-?�-_'------- - Water Supply: Public system JO—Community system ❑ Private ❑ Depth to Water Table %_rte_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Applica+ion Made: (If yes,date-------------------- ) No ❑ New Construction: Yes ❑ NoHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: \� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3 5 tic T P: Distance from nearest well_________________ Distance from foundation -------------------- Material ___--____________,____. "`4.. No. of compartments --------•----------------- Size ---------------•---------------- Li Liquid de }h -------------------- I q P� ----- Capacity-----= -----------�-�-r osal e d: Distance from nearest well._tiAC1 Distance from foundation ____/-_____.Distance to nearest lot I Number of lines --------- ------------- ___________ Length of each line_______ 40--! ---- Width of trench ____ --_tom : jC Vii_---_ odd Type of -filter material___-' .--Depth of filter material ----..�-�-it.._---Total' length -- -- f--------------------- 1 See e Pit: Distance to nearest -well ____�_Q +Tse___ Distance from foundation____ Distance to nearest lot line _____.)______._ Number of pits- --- I_-------------- Lining material__- _____.__ _ Size: Diameter_-- ...... / t -� �---Depth_.__.c�,-_�'r-------------•- - Cesspool: Distance from nearest well_____ ------------ Distance from f ndation.__:- ------------- .Lining material ___.___-...._______-._________ ------Depth---------------------------------------------------._Liquid Capacity._ gals. Size: Diameter-------------------•=- Privy: Distance from nearest well -------------------------------------------- .---- Distance from nearest building -._._.__________--_______ Distance to nearest lot line Remodeling and/or repairing (describe):-- ------------ --------------------------- ---- ----------------------------------- ------------------------ --------------------------- aA I ----------- -- - -- - -- -------------------- -------------------- ----- i I hereby certify that I have prepared this application and that the work will be done in 'Accordance with San Joaquin County ordinances, StaUl laws and rules andregulations of the San Joaquin Local Health District. LSi ned� _ . g ) `l t,� a Contractor) By: ---------•------------------------------ - (Title)-------------------------------------------------.----... (Plot plan, showing size of lot, location of system in relat' o wells, buildings, can be placed on reverse side). a l/ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---- .. - - ---- --- ---- ------------------------------------ DATE -_42 - REVIEWED BY------- --- ------------ ' DATE - -----------------•------------- UILDfNG PERMIT ISSUED--------------------------------------------------------------•----------------------• DATE ------------ Alterations and/or recommendations------------------------ ... --------------------------- ---- ----- - _---------- l� a - 7/_Z_ ---- --- - -- •---•------------------- - - - -------------------------- --------------------------•---------------•-------------------------••---------... •-------- ------ FINAL INSPECTION BY:._.. ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lodi, California 95.9 REVIc CO e•59 F.P.Go, 2M a -do 124 Sycamore Street 205 West 9th Street Manteca, California Tracy, California