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FOR OFF U 3 ` k r -------- ------------ - Permit No. - =APPLICATION. FOR SANITATION PERMIT (Complete in Duplicate) Date issued - ---------s-- -------- ------------------------------- This Permit Expires 1 Year From Date Issued ------------ - ' p Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. This applicatiori is made incompliance with County Ord' nce No'--549 l 'V JOB ADDRESS AND LO ON --- .----f -------• .. Phone ------- Owner's Name---------- ------------•----•----�^ . . _ �` � --- -- - `C�� i ------------------- T,c.. Address __..�•fI Phone--.----•-------- �a_ ��..... C�..� -C-T _---------- Contractor's Name---------------• p Installation will serve: Residence I Apartment Houses❑ Commercial..❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.�_. Number of bedrooms - - Number of 130+hs _______ Lot sire __.__________________ __ _ _ ____ __ Water Supply: Public 'system Community system ❑ Private ❑' Depth to Water Table R-5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ NoClay ❑FFANA t s H rd an ❑ i Previous Application Made: (If yes',-dafie:__:_._-'---�=,] No F1New Const ctian: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .4 (No septic tank or cesspool permitted if.public sewer is available within 2004eet.) S t• Tank: Distance from nearest well---------- -----Distance.from foundation r foundfa-tion- Material---_------ quid de th__ Capacity__.___.___..-___.___. tNo. of compartments----------- --------------Size ///"' Dispos I Fisld:. Distance from nearest well----S�"_._Distance from foundefion.._.��1-.----Distance to nearest lot Iine_-__.�__-..__ ;, Width of trench- -__. ,. ----- Number of lines--------------- __ Length of each line__-,_____ ' �� Type of filter material------ of filter material---___-.- _-_-_-_--.Total length---------- / Seepage Pit:' Distance to nearest well---.--.lee Distance from foundation Dia titer_ 3 ice to peptlst lot �/._---- Number of Pits---------1-----------Lining material------ q Distance fronearest well___._-____'___..-,Distance from foundation_________ __ _____Lining material____--------------------------------- Cesspool: _____.________. __.__.____ _.. Cesspool: Liquid Capacity gals. Size: Diameter-- -----` ----Depth----------------------------- - ❑ Distance from nearest building Distance from •n artist well------ _ _� �._ .r-- - --- Privy: r ..Distance to nearest of inti---------.________:_ ----------------------------------- ------------ ------- Remodeling and/or repairing (describe)-----------------------_____- = -----••------------------------------- i � r ---------------------- .- -----,- -- --------- `-----�"----------------•---•---------------------------------'--------------'-------•---------------'•------•th -- I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. -' and/or tact i [Owner a d/o Con+ orl I (Signed)-- = ---- --- ' ---- -----trifle)--------- e , } BY= ; 1 [Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - f APPLICATION ACCEPTED BY..--- -------------------------- ---------------------------------------- DATE------ ------------ ------ ------------------------------------------ --- --------------- BUILDING PERMIT ISSUED--------------------=------•------------------------- - -------------- ► G�/ h mendations'----------'------- -----lter tions /or reco - Q ----------- - -------- - ------- ------------ ---------- L ---------------- ------------------------- (v � ----------------------- FINAL INSPECTION BY:� ' _ --'--=--•=---- Date------- ..� SAN JOA IN LOCAL HEALTH DISTRICT 130 South AmeWc`an Stress 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eb-9 pEVI9E�o-59 r-P.CG.SM 6-6o