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FOR OFFI EUS r .---.-.-_.------------ ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No.....��i..8 -Z -------------------------------------------------------- (Complete in Duplicate) "This Permit Ex ices 1 Year From Date Issued Date Issued ......... ....... /_y X Application is -hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO AT N Owner's Name _ ------••-----•--_•--• k ------ Phone ---------=------- Address------ .. _ Contractor's Name_ .__ -- ------------------------------------------------------------------•--------- Phone ............... .••------- --------- Installation will serve: Residence �-partmeiit House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -"- Number of baths. Lot size _""_._.,��__.___._--•-. """_""-_•__ Water Supply: Public system ❑ Community system �ivate ❑ Depth to Water Table " ft Character of soil to a depth of 3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date"--"""""""..__ j No ❑ "New Construction: Yes ❑ No ❑ . FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) , Septic Tank: D3 stance frorn nearest we *_;_- Distance Tm_' ------------- No.` of compartments----- --------- ----- Size_ ro - _r -✓r -_5_& --,=--Liquid dep�h--'Y------------- Capacity.-• - --r`J------- Disposal Field: "s, Distance from nearest well .----- Distance from foundation ---- 0 --------- Distance to nearest lot liner Number of lines_-_"_--�_-�"--_Length of each line---..�77//r Width of trenchdl-�,- Type of filter material -1 �_i - Depth of filter material --- _____________"Total length ----- _Seepage Pit: Distance to nearest well_--_---"..__- ":" Distance fr fo anon --/,f ----- is t ce to nearest lot line!+-"""""._ Number of pits -----a-�----------- Lining material-- -._i- Diameter_ ------- .Dept h-------- r., Cesspool: Distance from nearest well----------------- Distance from foundation ---------------- "_-.Lining material""". __.------ _-_ ❑ Size: Diameter------------------------------------Depth-------------------------- ------------------ fin -Liquid Capacity ----------- •---------------- gals, Privy:' Distance from nearest well ----------------+_.--"-------------- ------------Distance from nearest building--:__-"""--..""_"__ ., Distance.to nearest lot Line ------------------ ------ ' ------------••- Remodeling and/or repairing (describe)------------- -"--•"-------•----------------•------ ---------------------------•---------------------- ----------------•-------- -- =---=-------• ------------------------------•---------------------------•----------------•-----------"-------------------------- --------- 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 ret' tions- of the San Joaquin Local Health District. . - -------- (Signed) _--------------- r Contractor) 1 ----------------------------- ---------- 7 o BY: --------------------- ------------------ --- ---------`-'=--------------------------- (Title) = �� ............------------------ I (Plot plan, showing size of lot, locatio system. in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION fACCEPTEb 13Y `- C"-`-- ��- - —------------------------ DATE REVIEWEDBY = =--------------------------------------- --------------------------------------------- ------------ DATE BUILDING PERMIT ISSUED ------------------- °------------------------••----------------.-------------------- •------ - - - - -- DATE Alterations and/or recommendations ------------------- _ _ w - - �. --------------------------------------------------------•------------ ----- -------------------------------•----------••----------------------.------ -------- -------------------------------------- -----------------------------------------•-- ----------------------------------------------- ----------------------------------------------------------- ----------------- ------------ -------------•----- ---------------------------- FINALw,INSPECTION BY:. - - -z�1 � �--- / Date------ ------------------------ ... � SAN J'OAQUIN LOCAL HEALTH DISTRICT t. . r i 30 South American Street"'1300' West Oak Streeti 124 5 cainore{5lreet y 205 West 9th Street ` Stockton, California Lodi, California ,� Manteca, Callfornia' Tracy, California ' E8-9 FEVIBED &•59 F,P,00. 2M 6.60 y