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FOR-�OFFICE USE-. APPLICATION FOR SANITATION PERMIT Permit No.------------------- ------------------------------------------------ ---- CiDuplicate)-- (Complete n upcae) - Date Issued ....��------_--_-- ----------------- This Permit Expires 1 Year From 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 LOCATION-._.-. -- ---- ------'-------- : ------------------------------------------I------------------------- Owner's ------Y------------------------------••••I------------------------- Owner's Name _ --- Phone._.--... �` --------- - Address------- �Q r� -'--•--- Contractor's Name-------------------- ------- Phone................................... Installation will serve: Residence...VY"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f-_ Number of bedrooms -?-_ Number of baths _/--_ Lot size ;�7 - l� - ------------------------------- i Water Supply: Public system ❑ Community system 2--l-p-rivate ❑ Depth to Water Table .,Kfft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes gj-'No ❑ FHA/VA: Yes P--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic T k: Distance from nearest well-------`-__Distance from fou ndation.-/49------_---.Material-&-6- -- ----_-- --------------- No. of compartments-.._-�---------------Size_�X�__-//K _____Liquid depth._.��`---------------Capacity-.��----.--- � Disposal Field: Distance from nearest well from foundation--��.�.....Distance to,nearest lot line-�_�-.----. - x Number of lines- -.___ _._--- - - Length of each line---_�-� Width of french----A-1--- ------------------- �- , g � Type of filter material,�,�f&_-"Depth of filter material-_/2------------Total length_-__,�o -- 1;1 Ilk it: Distance to nearest'well----- ..�"-----Distance from fou dation----,11Q_f__.Distance to nearest lot Number of pits__,�— Lining material_�V.G--G----Size: Diamefer_�U"K._-.----Depth-.� l-_-----__----_ Cesspool: Distance from nearest well-----------------Distance from foundation____-----_.-- --_-.Lining material----------------------------------- ❑ Size: Diameter------------------------------------ Depth-----------------------------------------------------Liquid Capacity----- -------gals. Privy:: Distance from nearest well------------------------------------.---------------Distance from nearest building----------------------------------.------ . ❑ Distance to nearestlot line------------------------------------`-------------------- ----------------------------------•----------------------------------- Remodeling and/or repairing (describes:------ T - --------- ---------------------------------------- ----------------------------------------------------------------------•----------------------------•-------------------------------•---------- ----------------------------------------------------------------------- F ----------------•-•---- 1 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 regulations of the San Joaquin Local Health District. (Signed) F 9 )-------------------------- --- - r Contractor) or By:--------------------- ------------------------- -------- ----- Z"-�w---=-------- - -•--- -----{Title) -------------------------------------- (Plot - (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED --------•---------------- DATE----^ / ----------------------- REVIEWEDBY-------------------------------------------- --------------------•------------- ---- ---------------------------------------- DATE----------------------- •--•-------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- *----------- DATE. r: -------------------------------- . Alterationsand/or recommendations---------------------------------------------- - -------------------------•--------------------•-•------------•-----------------•----------•------_---------- ------ --------c------------ --•--•-•-••--•-------------------•-• ----------------•-------•----------- 2-----f- -- --- - - --- � ---------------------------------------- - - ---- ------------------------------------------------------- -•-- ------------------------------------------ --------.----------------------------------------------------------- FINAL INSPECTION BY: -� i1_-- Date ? " ' 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 ES-9 REVISED e-59 F.P.E .2M 6.60 [