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FO OFFIC SE ? - - 1 ,-_ - APPLICATION FOR SANITATION PERMIT Permit No. .. .................. -------------------- ---- (Complete in Duplicate) - Date Issued ._..��.._Z __------------------------____-............- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distriet 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 LOCAT ON__y.O1f__ r----11� W--�/�-Pe- -------4----------------------------------------------------------.---------------------------------- 0 •-- --------- .--- OwName-- - -e Phone- ------------------------------ : !� �yaC( lf _ -- =----------------------------------- ------------ - - � ------- ---------------------- � -. ___ _ _Address_.---••------1�- Con#rector's Name Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ 1, d Number of living units: ..J�--- Number of bedrooms _��__-- Number of baths ../__ Lot size#�� ---A-�./................._._______ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3 Clay ❑ Adobe 2---Hardpart ❑ Previous Application Made: (if yes,date __._.._.....__-)__No � New Construction: Yes E3 No 2?— NA/VA: Yes E] No TYPE OF INSTALLATION AND SPEC IFICATIONS¢-�.�_..,� _,. . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tapk: Distance from nearest well--------:__� ,Distance from f6urid;a_tion--------------------Material.....----.___._...--_- --------._....-------.._. NoI of compartments Size ___-....�_- —Liquid de th----------------- -Capacityi Disppsal eld: Distance from nearest 'Well.-.--�------Distance frorry foundation---le__/._-...Distance to nearest lot line.. 111 / _~ ber of lines._..._.._...�___ ___________ Length of each line 4� __--------_----Width of trench---t_f�__..._------------------- Num ..- i �s 0 I Type of filter material� Depth of filter materlalf..,l�...._-._.-.Total length...._..�ir�.. ........................ Seepage Pit: Distance to nearest-well-----.'......Distance from fo ndation_:. _._......Distance to nearest lot iin�e.. .T.....-.. Number of pits_____ _________ _ Lining material._ � _.Size: Diam6ter. -._----Depth. t -..f----_-------._ �} Ik Cesspool: Distance from nearest well .--..�'"Distance from foundation �\' E s .Lining material.....-. ........................ Size: Diameter. - i Is ' Depth.- �C qu c1 Capacity ---------=-'.`= =9a . ' Privy: Distance from nearest well........... ....--------------------------- .... from nearest building------------------------------------------ ❑ Distance to nearest lot line:.. ----- ---------- .-•"'�_-----�=`--•--•------------•---------------------------------------------------------------------- Remodeling and/or repairing (describe): -----I------------- - ---------- --------------•--------------- --•----------------•--------------------------------=--=-=-----••------�------ -----I-------------------------------------------------------- -r ---------------------•-------------------------------•...-----------------------------------------• -------------------------------------------------------.....------------------ ------------------------------- ------------ I hereby certify that I have prepared this application'and that the work'v;3ll'6e-done in accordance with San Joaquin County ordinances, State la and rules a regulations Spn Joaquin Local palth District. Si ned CLl_lJ. r----------------- -•- (Owner and/or Contractor) 4 I Piot plan, showing size of lot, location of system m in relation to wells, buildings,t B ----- ( � g y 'etc., can be placed on reverse side). FOR-DEPARTMENT-USE ON Y APPLICATIONACCEPTED BY------------ -------- --------------- =-------------- -r < /------------ DATE--------- --r ---- -✓----------------------------- REVIEWEDBY-------------------------------------------- -----------------------------------7--------------- ---------------------_-- DATE--------------------••----------------------------•------- BUILDINGPERMIT ISSUED--------_------------------•-------------------------------------------------------------------------- DATE---------------------------=-------I------------------------ Alterations and/or rec m ndaf* :._: ----------------------- -- ,--= r--• - ----------- b` 7 ©� �` = =/ ---•--- ------=-------- - ................ -------------------------------------- ------------------------------------------•---------------------------•------------------------------------------------ rY - ----------------- Date.----------3 u �- ---- FINAL INSPECTION BY:..... --- SAN JOAQUIN LOCAL HEALTH DISTRICT k � 130 South American Street 300 West Oak Street 1,124 Sycomore_Street 205 West 9th Street Stockton,California Lodi,Californru ` 'Locmteca,Calif rnia Tracy,California l E9-9 REVISED-59 F.Y.EO.aM 6-60 - •Nw, ..