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FOR OFFICE USE: y -714 47ST �( Permit No. ... ....-..._...... __ _ APPLICATION FOR SANITATION PERMIT ------------- ---•---------------------------------- (Complete in Duplicate) .__.---________________________________________----- ___ This Permit Expires 1 Year From Date Issued Date Issued 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 compliancewithCounty Ordinance No. 549. JOBADDRESS A CATION -/-`x,-`33" G_11 _ -!-------------------------------------------------------------•----------------------------------•------- t .. ------ ----- ••------ Phone...... v: Owner's Name ------------------------------ - - - - -------------------------------- Contractor's Name-- 7. -------•-•-•-•----•----•--•-------------- ---•------------------------------------------•------------- Phone................................... Installation will serve: : Residence E3"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s z Number of living units: .1�____ Number of bedrooms .,7___ Number of baths .1____ Lot size _7_.._l� _�__.1................................ � Water Supply: Public system P--tommunity system ElPrivate ❑ Depth To Water Table L---_ ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er"Rardpan ❑ Previous Application Made: (If yes,date___________________) No New Construction: Yes ErNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: F. (No septic tank or cesspool permitted.if public sewer its available within 200 feet.) Septic Tank: Distance from nearest we1.l�_----_____ Distance from foundation_./_d_............Material___/ e .................... No. of compartments--- =:4-----------------Size----- - _3 -- ----Liquid depth_._- -_.-_.---:._------..Capacity--_a-dA Disposal Field: Distance from nearest well---- --------Distance from foundation___-- ---_______Distance to nearest lot line_-sS''__-•--_ Number of lines______.. --------------------Length of each line-----7�`_'______--_-Width of trench_A-k-_`-...-.---------------- Type of filter material._?k4__k-------Depth of filter material../h-"_`_-----------Total length_____/_Z:p__________________________ j Seepage Pit: Distance to nearest well___`~----------Distance from foundation---1.6_.....__._..Distance to nearest lot line___S ®� Number of pits---------�--"""--_Lining material____!"Rb_C_k---.Size. Diameter____3.3_`--______--Depth-wZ_sS '___________________ I CA 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 nearest lot line----------------------------------------------------------------------------•----------------------.._--------------------------------------- Remodelingand/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 regulations of the San Joaquin Local Health District. (Signed)-------------------------------------------------------------- ------ -------------- -- ----------------•-•----------------------------•--•---•------------(Owner and/or Contractor) , ------------------ "- ---- ---------------------------- --------------•--------------•--------(Title)------------•---•---------------------- -------------------- (Plot ----- - -----------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- 1 -- - "--"-- ---------- ---------------------------------------- DATE-•-j--- ��+' r REVIEWEDBY-------------------------------------------- --------------- DATE------------ -------------------..............-------------- BUILDINGPERMIT ISSUED----------------------- --------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommen atiogs ------ --r--------- -•-•-•---- --• •- ----------- •--I ---------------------- __________________________________ _ r� _ __... Y.. ../-__.____._-_- _2_____..._.____.___.-____-________._______..______-..-..__-_._.______________________._._..__._______-.___._______--- FINAL INSPECTION BY:----- Date----- -- ----• --------------------••--_ SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 91h Street Stockton,California --Lodi,California Manteca,California Tracy,California k 8 _ ES 9 REWSED e•59 2M 5-62 ATLA5 °•p r