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F R OFFICE USE: �p q IS 'x/24 , �------------------ - (�h - / ��3S ----------------------------------------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ...�_____ (Complete in Duplicate) _---___________________________________________________ This Permit Expires 1 Year From Date Issued �J 14 c/ 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. 1 JOB ADDRESS AND LOCATION lf'� -£ ----• -- --------------------- Owner's Name_ __ J Phone______� C� - 3os�-- ------------------------------------------------------- ------------ Address -•-------------------------------- -- ------------------------------------------ Contractor's Name------- - _ Phone----------------------------------- - Installation will serve: Residents Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: l:.__-- Number of bedrooms ---/.- Number of baths _ Lot size --- ---:-------------•-------- Water Supply: Public system ❑ Community system ❑ Private D?"D—epth to Water Table _flw*P_t1 Character of soil to a depth of 3 feet: San 6 G�ravel [I Sandy Loam ❑ Clay Loam [-] Clay F] Adobe �ardpan [:1 Previous Application Made: (Ifyes,d e___._- !- --- 02No cConstruc io Yes El No �'FHANA: es ElNom - 7 1S� d. �b TYPE OF INSTALLATION AND SPECIFICATIONS: 'V {� {Na septic tank or cesspool perrni4ed if public sewer is available within 200 feet.] I-& Material Septic lank: Distance from nearest well---��_____Distance fEom foundation-____ _-- � No. of com artments--___ ____--i- -Size_f Liquid depth----�-___------.....Capacity-- 01V > ' - ?,�-______-.Distance to nearest lot line---A�%_____ r i Disposal Field: Distance from neares# well-__ _-Distance_frgfii foundation__ _-� Number of lines---•--- -----__-- ength of each line------ --------------Widthrof trench-_:z---- --_----------------- ti I Type of filter maferial__�,��-�Depth b'f�.fi ter mater�a!____,,�e_____---Total length_-_-_ __�-----•------ ------•---- 5eepage Pit: Dista �e'�tiest well_________ ________Distance from foundation__--_________-.___..Distance to nearest lot line____.-_____.___-_ Number of pits_-------------------Lining material----------------------Size: Diameter-------------------- Depth Cesspool: Distance from nearest well________________Distance from foundation------------------- Lining material_-.-__-_-___--.___-._____-_.________ ❑ -----Depth--------- ------------------------------------------Liquid Capacity_-------------------------gals./d Size: Diameter_---------------------------- - � . nearest well ---------------------------------------- --Distance from nearest buiHing------------------------------------------ r Privy: Distance from ❑ Distance to nearest lot line------------------------------------------------ ------------------------------------------------------- F ----��---- -_ _--------- i-----•-------------- Remodeling and/or repairing (describe]--------------- = ---------•------------------------------•----•---------- ti. I __ _ --------------------------•-----•--•--------------- ------------•-----------------------------------•----------------------------------------------------- ------- li t ---------•-------------------•------------------------------------------------------------------------- Z. - - - -- ----- ---------------------------------------- ------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin our, y ordinances. State laws, and ules and regulations of the San Joaquin Local Health District. � (Avrnet +df or Contractor) (Signed)-------------- - - -------- - -- . _.,.�. _- --------- --� ------------------------ -- - _ Title � ---- - - ( (Plot plan, showing size of loft, location of system in tion to wells, buildings, etc., can be placed on reverse side]. WO FOR DEPARTMENT USE ONLY DATE--------- APPLICATION ACCEPTED BY_._____- =-- ---------- �f e y = -- DATE------------------- ------------------- ------------------ REVIEWED BY---------------------•----------------------- ----- ----------------------------------------------------------- -- BUILDING PERMIT ISSUED------------------------- ----- DATE Alterations and/or recommendations: ------- --- --------------I-------------------------------------------------------------------------------------------------------- ---------------•----------------------------------------•----------------------•----••----•------------------------- ---------------------ear- - ---• -------------------------------------------- -------------------------------------------- -- FINAL INSPECTION BY:----- L-� ------- Date- ----------;7f_x =6x------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California - ES 9 REVIS90 6-59 3M 3-'63 F.P.CC. -