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FOR OFFICE USE: =} APPLICATION FOR SANITATION PERMIT Permit No. ......... 1 ----------- - ------- ---------------------------- (Complete in Duplicate) Date Issued //It // f ---------------------------------------------------------- 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 c m Bance with County Ordinance No. 549. flE)�� 0s'o --(to JOS ADDRESS AND LO ATIONA---�'---��"?_- Lt�cf�L ----- = —p= � ]Yf ......................... Owner's Name.--- Address----....-/ ------ ---- ✓ � -----------------------------p--h--o--n--e--.-------v---.-.----------1--•.-7--- -----•- Contrac:tor's Name---------- -.------•-------------•-----------------------------•-------•-----••---•-------------------------------- Phone"/_Q... -.rLl__7f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other'K Number of living units: __I___ Number of bedrooms .,Z- Number of baths ________ Lot size Water Supply: Public system ❑ Community system ❑ private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s7er is available within 200 feet.) r Q Septic Tank: Distance from nearest well___ _.__Distance from foundation______r_Q_______-Material__._ _ . `-L ilJ>t . ----•---- El No. of compartments...__.,____-o?---------Size_______ Liquid depth__________ ___ Capacity_____NL0C�_9_q� Disposal Field: Distance from nearest well---11- ----Distance from foundation------/4--------Distance to nearest lot line_______ Number of lines--------------�------------Length of each line------------ ---'--------Width of trench------------ ------- Type of filter material _ _._ _Depth of filter material_______/_ __��____._Total length______________�_ _0--�.. .._ _.- �� Seepage Pit: Distance to nearest well------------_--------Distance from foundation....................Distance to nearest lot line_________________ 1 f ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Dept h-------••-------•-•--------_.---- 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 lin e-------------------------------------------------------------------------------�---•--•----••------------------°--------------/--►-----t------r------f------ rep rescbe)o - ------------ r J1 ----- ---- --- ------------------ Q------Remodeling and/ _ d , _ - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules end re lations of th San Joaquin Local Health District. �- '// `� (Signed)-A------ - - -- -- -------------------------------------------------------------------------•--------------Owner and/or Contractor) By: --------------------------------------------------------------------------------------------• ------------------------------(Title)-------------------------------------------- - -- -------------- I (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -� -------------------------------------- DATE----_-��--` s� --------------------------------- z REVIEVI/ED BY -"- - -- --- -- -- DATE t ��.'BUILDING PERMIT ISSUED--- •------ •---------- ----- ------------- -•----------------------------------------- DATE-------•-- ------ ---------------------------------------- x - ------------ --.----- e _ - Alterations and/or recommendations:--_P .. `1�v-"' �=_ � ¢- '�_____ "` _-_.._�'�` :fi__________ _' ___ "`` ._..+ rE: -------------- ---------- -- �a _ • z ' f, --�--------------- ----- lzz- --- C INAL INSPECTION BY---------------------------------------------------------------- Date------- ---------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 it EVIBEC 9-59 F.P.CC.2M 6.60 I �