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FOR OFFICE USE: -------------------= -_ `--------------- -------------------------------- - APPLICATION FOR SANITATION PERMIT Permit Iio....�..7.G'.. ------ ' -- •--------------------- ---- -- (Complete in Duplicate) �" _ (t, _ G1A I t' Date Issued-.�.............. ____________ ____ -` This Permit Expires 1 Year From Date Issued 4 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. x, e ° f JOB ADDRESS AND LOCATION _.-v��-t��- :moi: Owner's Name ---•------------ ------------- ---------- Phone - ................. Address....... ..--------......................................... }.I----------------•----------------------------•-----------•-----------....--------------------•--- _ Contractor's Name.... ._5_._ - ?2!! ."".-___.__,�-�_.-V..,_?_ /0._6..4A?�hone.,Z_---- Installation Installation will serve: Residence G& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ___ Number of bedrooms .-AV Number of baths --- /_ Lot'size _.._...._ 4 Water Supply: Public system ❑ Community system ❑ Privateg Depth to WaterTable -------- ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam jj Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,date____________________) No a New Construction: Yes QQ No ❑ FHA/VA: Yes ❑ No4 (- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --_ :Tank: S Distance from - • L `de�_ Mateall .0 �� �°�� Distance from foundation _ _� Septic Tank: Distance from nearest well a- No. of compartments --__----------------q p, p y Disposal Field: Distance from nearest well s ----_Distance from foundation__ ,l Distance to nearest lot line t.$-------- - Number of lines_______________ ___ Length of each line_________ ___._ _...Width of trench_____..___,.-.__.__-___ i�� a a � Type Depth of filter material_____1__..-Total length ------- --- T e of filter material_. _ :__ .. ........................ Seepage Pit: Distance to nearest well ------- _-------------- Distance from foundation .................... to nearest lot line ------------ h; ❑ Number of pits------- _-------------- Lining material ----------------------- Size: Diameter ----------------------- Depth ------------------- _____._-____- Cesspool: Distance from nearest well:-__________.__ Distance from foundation ---_--------------- Lining material ------ .---------------- _______........ p�9 ❑ Size: Diameter ------------------------------------- Depth ---------------------------------- ------------------ Liquid Capacity ---------------------------- gals. �b Privy: Distance from nearest Well ----------- __------------------------------------ Distance from nearest building ------------ ..-_-_-_.__-___________-___._- ❑ Distance to nearest lot line---- ---------------------------------------------------------------------------•-------------------------------------------------------- QS Remo elfin nd/or repairri,�nnjd. fin.---° 2. 7_ 0-1,-4 4 -- _ s .%K------ I hereby certify that I have prepared this app li -'ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the San Joaquin Local Health District. k (Signed) --------------------- ._-----.(Owner and or Contractor) By: ------------------------------------------------------------- ----------------------------------- --�=--=----=-----------------------(Title)----------------------------------- •..--------------------- (Plot,plan, showing"size-of lot, location -of�system-in.relation to wells, buildings, etc., can -be placed..onvreverse side).._ _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---,--a'��Cr=�'•` -sS DATE ..-�� '«' f REVIEWEDBY ----------------------------------------- ----•----------------- -------------------------- ------ DATE ...... ......... . ------------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------- DATE.---------- ---•--------------------------------------------- Alterations and/or recommendations:---------='---------------'--------------------------------------------------------_-------------------------------------=---.._...-----•------------------ -----------•--------------------------------------------------------------------------- -- '---------------------•---•--- FINAL INSPECTION BY e4 ------- - - Date ------ ------ 7---- SAN ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E6.9 REVISED 6.59 F.P.DD. 2M 6.60