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r FOR OFFICE USE: — — ` .6 .... ....3..� .. APPLICATION FOR SANITATION PERMIT Permit F.No. ...... (Complete-in Duplicate) ..... ........... .- I 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 AN LOCATION.._ .'..,. _..Cr,Z ........................... ................ Owner's Name. .. „X..___..... . .. . ....................................... ..._....... Phone. ------•--..........--- Address----------- ;9,77y � .._ C -Contractor's Name_.Name-.. .._ /. ................. Phone.. .11............................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3�... Lot size Number of living units: . �.... Number of bedrooms , ._- Number of baths --- �1:�ilL�i!f.... ......... Water Supply: Public system ❑ Community system ❑ Private 2-"D`epth to Water Table .4-P ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ade13—Hand Pan E]Previous Application Made: (If yes,date...... _.) No 8---New Construction: Yes [3No PT� liFHA/VA: Yes ❑ No Eq` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Distance from nearesr weil...... ..........Distance from foundation. ......._.._.----Material------ ......_L_. No. o compartments.. ........... . -------Size....----------_.. ............Liquid depth........... i Capacity- ---- - ........ Disposal/�F old: Distance from nearest well.:jQQ!- ..•D;stance from foundation_r�. _...Distance to nearest lot line_ -�...- OV141( Number of lines .11J -...__._--- - - Length of each IineS -. m]rc.-..-Widfh of french.... ....... .......... Type of f,rer maieria,70C/(---...-. .Depth of filter rnaterial-.Jg•"- p ' Total length �� ..... . Seepage Pit: Distance to nearest well_f -, r ii ....__.QiStar,ce from foundation...w'Zs1'....__._.Dista.nce to nearest lot line...=�.�-..-- [�'� Number a- pits... -r�...... ...Linin material-- G./t__.'Size: Diameter 3•_ • p ' '..Z�— g - � � �-�- --.De to ill... . :' . .......... ... .. ......... Cesspool. Distance from nearest well.................Distance from ioun'dation_...... ..........Lining materiai_.....II I S'ze: Diameter.'__._._.__. - ............._._.Depth ..... -- •"--- - --.. ............... Liquid Capacity. ." .--.... ---- ....gals. Privy: DiOar.,ce from nearest well r ...... ..........._... .Dista.nce from nearest building.. ��..---., ..... •- � Disfance to nearest lot tine.... ....... �. Remodclina anclZor re airm9 (aescribej: .� _.. •-•••---•----- •._.-..----- •........ ............._.. 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 drregulatio s of the San Joaquin Local Health District- ,�� Ii� (Signed)_____... . A. _._._t_ (/1�/_--- --(Owner and/or Contractor) By:-------------------------- - - - ----- ----- i .-----(Title) 9 p , , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY y ............._ - -•-...._._.._._. ...._ ._._ .. ....---_-.... DATE..... . �l -;/— r RZ-VIEWF� BY............ ...._...__..................__.._..-- ....._............. DATE_.__.................._ II c� UILDING PERMIT ISSUED............ --- ------- ---------------- ............ OATE. d Alterations and/or recommondations:-_._._-._ '... I� .............................. ................ u ....... . ........... .••-•................................... . ii ...... . ... ..... .._..._...... ............... ........... ..----•.............................. ............................. . FINAL INSPECTION BY: ....--�- ^ / ) r" - a... Date... SAN JOAQUIN LOCAL HEALTH DISTRICT I / t 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 0th Street Stockton,California Lodi,California Manteca,California " Tracy,California F.P.CO. J f