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s . . .. FOR OFFICE U F: ------------------------- -- ------_--- APPLICATION FOR SANITATION PERMIT Permit No. _.L.......7--- - -- ------------------------------- ------------------------ (Complete in Duplicate) 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 aaplication Is made in compliance with County Ordinance No. 549. LK JOB AD�RES�A ' Tr:`�.�t l- J -- ------r_ Owner's Name- ------= Address--- -----.-------------------------------------------------------------- Contractor's Nama_ E� � -..c --�• ----------------- -•-- ----r � Installation will serve: Residence ❑ Apartment House ❑ Commercial (5'Trailer C r� Number of living units: _ Number of bedrooms -------- Number of baths _..... Lc ._--.-__.____ � Water Supply: Public system ❑ Community system ❑ Private P!r Depth to Watei k i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay A o e ardpan ❑ Previous Application Made: {If yes,date--------------------a No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well=�_0_� istance from foundation_Ae-------------.Material - _y__._.___ _ No. of compartments------ �-- --- Li uid de th_--__ _ - --------------CapaciU___U__ Disposal Field: Distance from nearest w it�r�:_r Distance from foundation---10------------Distance to nearest lot line---+s`_______- Number of lines______ ' - Length of each line_____ ------------------------- ------------------------- Type _________�7 -Z _- -------------- Width of trench. -" Type of filter material_----- _-.bepth of filter material__=1_ _`____.___Total length___.-/.. _________________________ I Seepage Pit: Distance to nearest well__'--------------_____Distance from foundation....................Distance to nearest lot line----------------- El Number of pits--------------------Lining material----------.------------Size: Diameter.----------------------Depth-----------------_-------------� Cesspool: Distance from nearest well2_---------------Distance from foundation--------------------Lining material__.____-_--_.--__-____-__________1 ❑ s Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------ga_. , Privy:° 'y - Distance from nearest w611' ------------------------------------------------- from nearest building------------------------------------------ ❑ Distance to nearest lot fine-----------------•----------------------------------------------------- ----------------------------•--------------------------- ---.------ j Remodeling and/or re airing (describe]:____- A � ,-_ --------------- I � ----- ----: y _ _ - ------------------------------------------------------------------------------------ I hereby certify that I have prepared this pplication and�that the work will be done in accordance with San Joaquin County 4 ordinances, State laws, and rules and q lati s of the an Joaquin Local Health District. ------- ---- ------ -------------- --- - ----- ----------------- (Signed)-------------------------------•------------------ • --- - -- -------�- - - - - - - - - (Owner and/or Contractor) By:-------------------------------------- -- -- - ------------------------------------- --------------------------------------(Title)---------- -------- -------------------- --------- ------ (Plot plan, showing size of o , ion of systein in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ----------------------------------------------------------•--- DATE-----,°. .------�-�------�-•-�---------- -- REVIEWED BY --- --------- - --------------- DATE BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------------• DATE_.-------------------------------------------------- Alterations and/or recommendations:------------------------------------ "- --------._....-... ---------•---•--- --------------•-•------•=•----------------•----.-------------------••--•--- -------------------------------------------------------------------------------------------------------------------•---------------------•------------•-----------------------------------------------------------.... _..._ --------------•-------------- ; ------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------•------------------------------------- ---- ---------- ---------------------------------------------------•----------------------------------------------------------------- ----------------------------------------------------- ----- ti FINAL INSPECTION BY:---- Date- �� ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California E13-9 REVI9E9 9.99 F,P.CG,QM 6.60