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FOR OFFICE USE: ------------------------------------- ------------------__.----------------------------------- APPLICATION FOR SANITATION `PERMIT Permit No. ../._. __4. ----------------------------------------- -------- (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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATIO ._.'�{D *�i &P-'4f0WW-& Owner's Name-- •• '------------=---•-----•- ------------------- Phone------------------------------------ �n F r --------- ------------------•-I----------------------__---_. ....... 4 Contractor's Name ---- • •---- ------------------ -- ; ------------------------------------ -Phone- t.............................. Installation will serve: Residence 0,"Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel I] Other ❑ Number of living units: /_--_ Number of bedrooms-_ Number of baths/_--_ Lot size -----_-- •_ _-:-•- _----_-_ r Water Supply: Public rsystem C3Community system R3-�rivafie ❑ Depth to Water Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®/FI'ardpan ❑ Previous Application Made: 11f yes,date-- ,____ __________I No New Construction: -Yes WErNo ❑ FHA/VA: Yes g3+- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel=____ �-- Distance f� foundation--- I- te.rial__ G a ---------- Rol*" No. of compartments-.'-.:2 � quid ---- Cap Disposal Field: Distance from nearest well:-- --_.__.Distance from foundation__-� Distance to nearest-lot line__ Number of lines___'_ � .____ ' A. ---- --- --_-- Length of each line-- -- ___-- Width of trench-----•--------------------•-- Type of filter material, Depth of filter material--- length.--_�e1_ ___________________ Seepag Pit: Distance to nearest well-----7'� -_------- Distance from fo ndafion_A40_-____-__..Distance to nearest lot Number of pits---- --..__--_-Lining material _Size: Diameter_S�0�---_'___.Depth_ •:'- Cesspool: Distance from nearest well-------------- Distance from foundation-__-----------------Lining-material------°--------_____-------.-_--_.---. ❑ Size: Diameter------'-=-----------------------------Depth---------------------------------------------------- liquid• CapacitY-------------- ----------•-gals. Privy: Distance from nearest well_____________------------------------------------:Distance from neareiit building.._ _._________._.._-__________ i Distance to nearest lot line._:::_____ ___ Remodeling and/or repairing {describe) /�L-:6�"v - -- -------•---..-------•-•-•----- �- --------------•-•---------•---------- --- u '-------------------- -------------- ------------------------- ----- -. --- r ..-----------------------------------_ I'hereby cerfify-fhat I have"prepared this application'and that the work will;be done in accordance�wi+h San Joaquin County ordinances, State laws, and rul and regulations of the San Joaquin Local Health District. (Signed) r Contractor) ---- ------ -- .................... (Plot plan, showing size of lot, location of syst ' in rel,+ion to wells, buildings, etc.,'can be'placed on reverse side). # FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY Cz- /�=--eE-�e�f''-«•-�`-----` --------------------------- DATE `� -2./r to � f REVIEWEDBY -`-------------------------=-------------------------------------------------------------•--------------------. - DATE BUILDING PERMIT ISSUED--------------- :z >-------------------------------------------- -----------------------------------... DATE Alterations and/or recommendations:--------- ----------------------------------------------------------------------------------------- -_--------•---------------•------------ ------ ---------------- -2 - --------------------- --------------- - --- ��C4 ---•---------- --- -- --- ---------------------------- ------------- --------------------- - - ... ------ .--. FINAL INSPECTION ate ----------------- --------•-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California EB-9 REVIe EO B-39 JF^co�7M 6.6q -