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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permi+ No. ._�..��.�?.., - --------------------------------------------------------- / (Complete in Duplicate) f�I _. ----------------------- 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. i JOB ADDRESS AND OCATION --------- }----- S s------�---e�e_ -------------------------------------------- - `- /l r� Owner's Name----------- �'J {� A-�--Jz,4 ----------------- ----------- Phone- �-------- -------------------------- Owner's Name ---- -------------- ------------ Contractor's Name---------------)t:,:�- dd 0 1 ------ ---`--......._..-----..__...•-•-------------- Phone.. .............................. Installation will serve: Residence/❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l_-__ Number of bedrooms J. Number of baths Z. Lot size __�s.�X��„�i________________________ Water Supply: Public system ❑� Community system eprivate ❑ Depth to Water Table 1-41-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes d`_N_o ❑ FHA/VA: Yes P9--'NO ❑ TYPE OF INSTALLATION-AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.__ .lDistance from foundation-_/_,Q.-!______ Material f_ ------------ No. of compartments-------8),---_----------Size...._. a__X_,f49___Liquid depth___IV_%-------------Capacity------PQ...... Disposal field: Distance from nearest well---__ Distance from foundation___ Q_ ........Distance to nearest lot line...:a�_1----- Number of lines_______r� -- Length of each line______ .a _-_._ Width of french..... 1 � 17 Type of filter material_ra�_!�------.___Depth of filter material-----Ze___ ------Total length_____ ----------------- Seepage t: Distance to nearest well_____- Distance from foun'dation____,/0-f._-.Distance to nearest lot line-4--- r�� Number of pits----. -------Lining material.ar'Q�.�------Size: Diameter---3-3-1----------Depth--_c�_s�_./_...---------- Cesspool: Distance fi-om nearest well-----------------Distance from foundation:.,------------------Lining material-------_____--_______________________- ❑ Size: Diameter--------------------------------------Depth--------- -------------------- ---------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__------.___.________________..___.___.._ I ❑ Distance to nearest lot line---------------------------------------------------------------------------------------- --------------------------------------------------- ; Remodeling and/or repairing (describe)=------------------ ------------------ - -_. -----� ✓__--__----•----.--- -----•--------•-••-----•--------------------------------------•-------•------------------ -------------------------- - ----------------------- ---I------------------------------------------- ._._--..------------ ------- - - ---- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify fhat 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 Joaqui Local Health District. -------------�- i G(Owner and/or Contractor) By:------------------- - -- ------- - (Title)--------- (Signed) -------(Si ned) (Plot plan, showin f I lot, ocation of system in relation to wells, bbitQings, etc., can be placed on reverse side). EOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY_.. ...... e------------------------- DATE----- -.:lZ_` .[.-_-------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------•--------•-------- DATE.------- ---------------------------.._..---••-------------- BUILDING PERMIT ISSUED----------------------------------------.----------------------------------------------------------._ DATE---------------------------------- - Alterations and/or recommendations:---------------=----------------------------------------••---••----------••-------------------•----------------------------•---------------------------------- ----------------• ----------. --------------—----------------- ------- ----------------- - -- •---- y- -� - - °�� '_-�.-°`y---- -------- ---------------------- ------------------------------------ -------------------------- ---------- ----------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. .-\.:._ F Gt�� -res: Date__.____ .__ __�_�' / a >. 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 REVIBEO B-59 F.P.00.2M 6-60 r F