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FOR OFFICE USE: � ;s��A_. ------- ---- ---,_ -- APPLICATION FOR SANITATION PERMIT Peri+ No.___ .:_ _-. . -- - ----- ------ -- This Permit Expires(Complete in.Duplicate) / ' Issued Date Issued res 1 Year From ate Application,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. .1 ' Thislpplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC 1TI /N_.d.f-G_-_-_-_j--_--�-' ---- ---•-----------------------// ' A .ti Owners Name------------------ - '-- _ ------- Pone--- Address f T - ___________________________ ------------ ----------- _._ Contractor's Name-- !✓ ----------------------------------------- -------- Phone---- a Installation will serve:.,.Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 7? / y J .- I Number of-living units: _.�_�' umber of-bedrooms .3- Number of baths ___1_._ Lot size ___---- 3--_!1__.V15 _______________` Water Supply: Public system 5 Community system ❑ .Private [] Depth to Water Table _ t. L Character of soil to a depth of 3 feet: ;.Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe [D,-'f!ardpan ❑ Previous Application Made: (If yes,date'_- ____-_`.) 'No New Construction: Yes U�XNlo ❑ FHA/VA: Yes ❑ •-No'0_ TYPE OF INSTALLATION AND SPECIFICATIONS:° (No septic tankorcesspool permitted if,public sewer is available within 200 feet.) Septic 4% Distance fotimwnea.r,esat:swell___! gyre___Distancefrom fo ndation__._ Material --------------------- ---------- ;a No. 'of comparfinentsLiquid d th_ ` C Cp ty Ag I r - _t r Dispos' Field: Distance from nearest well----AiWC-Distance from foundation___-_��_--------Distance to nearest lot line___- _________ Number of lines_____________ Length of each line-A0-410=6.6_.Width of trench.---------- _ /. Type of.filter material ____ ._ _Depth of filter material--_-.---1/9-___.__._Total length----------------- �_--_-------_-._-- _� Seepag'f Pit: .Distance to'nearest'well---------__V&__Distance from foundation___•..IG � ..Distanf� to nearest lot line._.-�f......... N ,..� . .Number of i r Lining material--A-0-CA,---Size: Diameter-- - Delb4 - --------' q00P Cesspool: Distance from nearest well_---------------Distance from'foundation-------------------.Lining material_------------._r---- -----. ❑.. Size: Diameter----------------------------- -------De th-------------------------- ----------------- -Liquid Capacity ' al's. Privy: Distance from nearest.well-------------------------------------------------Distance from nearest building-:'----------`•-=-3= ..... .. ❑ Distance to nearest lot line--------------------------- ------------------•----------------=- --------------------------------------------- ---- r Remodeling and/or repairing (describe):------------------=----------------------------------------------------------•-------------------------------------------------------------- ------------•-•----- •--------- t-----------------------•--- •--•--------------- --------------------- ------------------------------------ --ti----------- ------------------------------------------------------------------------=-------•-------------------------------------------------------------------------------- -'Thereby certify that I have prepared this application and that the work will -be done in accordance with San Joaquin County 00 " ordinanceS,:�State laws, and rules"and regulations of the.San"Joaquin Local .Health District. (Signed)•- ------ I--- - ---- ----- ---- ---I------------------------- ---=------ -------------------------------- -----.....(Owner and/or Contractor) By:---------------------------------.........----- - ---------------------------------------------- _ =--------------(Title)-- ------------------- - ------------------------ (Plot plan, showing size of,lot,.loca+ion of system in relation to wells, buildings,' etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY ----------- ----- ---- DATE 4-------- 6 -- ------------------------- REVIEWEDBY------------------------------ - ----------------------------------------- -•- DATE----------------------- BUILDING PERMIT ISSUED----------------------------------------------------------- _--• `------------ -•--------------- DATE.--------------------------------- --- Alte ations an /or recom endations:_____._________.___________._ ------------------------------------ -- ---------------- --------- --- - ~ ---�------------ r '----------------------------------------------- -------------------------------------------------- i ------------------------------------------------•-------------------------------------;------------------------------------------------------------------------------------------------ ----------- ------------- ., --- --- FINAL INSPECTION BY:..-------C..'.�.G��------------------------------- Date-----__�a_--`�'� ._ ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 31A 3-'63 F.P-ca. . - 1