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FOR OFFICE USE: XZZa_,�.�/_wL/-------/f_a d��f -__-_-___-'_ __ _______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) --------------------------- 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. Tis application is made in compliance with County O dinance No. 549. JOB ADDRESS AND LOCATION---• ----- ...c --------------------•-•---•-------------------------------------------------------•------------ Owner's Name. -- ---------- Phone Address-----71Z �� - - -- ----- --- - Contractor's Name..._ E ---------- �- - - - Phone.. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____1__ Number of bedrooms _____!_ Number of baths ___/___ Lot size ______'P�X__X_/_ -�____________________________ Water Supply: Public system 0-'Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [5--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [L}-"'New Construction: Yes [�Va ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f { Septic Tank: Distance from nearest well: -e_Distance from foundation_1�._____--____Material____ ___ _ _________________________________ i No. of compartments.-_2:_—__-___--___Size____________/?X67X_9_Liquid depth____-.�/_ .....---------Capacity___�'f� Disposal Field: Distance from-nearest well___-7-tv_-A,P-_Distance from foundation___,r7- _`___-__-Distance to nearest lot Number of lines-_____4___----_-------------------Length of each line------8-p-----------------Width of trench-------- -4- ------------- Type of filter material___�,Loc_ --------Depth of filter material___- ..... length-------------amp___-___ __________ 1 Seepage Pit: Distance to nearest well______________ \; ________Distance from foundation....................Distance to nearest lot line_______________._ `t ❑ Number of pits-_'-----------------Lining material-----------------------Size: Diameter-----------------------Depth--_-_--_---_--------_--------.--- j Cesspool: Distance from nearest we'll-------------/_Distance from foundation.-------------------Lining material--------.___---____-___-_-___________- ❑ Size: Diameter------------------------------- --- Depth--------------------------- ------------------------Liquid Capacity----------------------___..gals. �. 1 , Privy: Distance from nearest well------------------------------------------------- from nearest building-----------------------.________-_ ❑; Distance to nearest lot line---------------------- -----------------------------------------•---•- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------- ---------•-----------------------•-------------------------------- ---------------------------------------------------------- ------------------------------•--------------------------- •--•------------------------------------------------.-------------------------------------------------- ------------------------------------ I 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 regul ns of he San Joaquin Local Health District. (Signed)----•---------------------- ------------------------- -------- --- --- ------- --------------------------------- -----------------------------------------(Owner and/or Contractor) G By; - -- ------ ---•-- ------ - -- - --- -------------- (Title) -------------- ------------------ (Plot plan, showing size of lot, location f system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY------------- == ------------------------•----•----------- DATE_____` _r_, � DBY---------------------------------------------------------------- -------------------------------------•-------------------- DATE---------------------•-----. .. BUILDINGPERMIT ISSUED------------- ----------------'---------------------------------------------------------------------- DATE---------------•--------------------- �.. _._.. Alterations and/or recommendations:------- - = s_ k I - - ------------ == __ 15e-,�------- ------------------------------------- -------------------------- ---- -------- ------ --------------- � --------------------------------------------------- --- FINAL`"INSPECTION BYE------ ---=`---=- .�.. ____________ ______________ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 i3 { 130 South American Street 300 West Oak Street 124 Sycamore Street 5 Wes!Stir Street,, +r f Stockton,California Lodi,California Manteca,California „Tracy,California k� E9-9 REViBED B•�S9/.P.0 O.2M 6•60 g �� .�