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FOR OFFICE USE: i -S Z --------------------------------------------------------- l . u q--71 APPLICATION FOR SANITATION PERMIT Permit No. ........................ ----------------- (Complete in Duplicated Date issued ___f ----------------------------------------------------------- Isued � _ C�fQo-- f I ApplicaThis Permit Expires 1 Year From Dat ion is hereby made to the San Joaquin Local Health District for a permit to construct nd install the work. erein described. This application is made in compliance with County Ordinance No. 549 G�wJOB ADDRESS AND C TION t -----_L ---�- �� riOwner's Name-----_. �_----- ------------- Phoneft* ( ice. --••------------------------ Address-...------------••� !L -C�, -------- ---------------------•-•--------------------------------------------------------_,--------------.--.--�---•---------------- ContrContractor's Nam actor's -- ----------------------------------------------------------------------------------. Phone. - Installation will serve: Residence E�parfment House ❑ Commercial ❑ Trailer Court ❑� Motel ❑ Other ❑ Number of living units: __ Number of bedrooms-- Number of baths /__ Lot size ----- __ __ ___ ________________________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 5 ft. Character of soil to a depth of 3 fee+: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay E] Adobe Hardpan 1-1Previous Application Made: (If yes,date_________________._) No ❑ New Construction: Yes ❑ No p- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - 2 $ctn. * Distance from nearest well_________________Distance from foundation-_.______________-Material_..________._________________________.__________-No. of compartments-------------------------Size-----•-- ------•------- ------Liquid claplh--------------------------Capacity------------------;--Disposal el Disfance from nearest eII --....-_Distance from foundation---3S___.....Distance to nearest lot line..... ....... ------------------ T r ®� Number of lines__________ _________________ Length of each line--------R_t�_1__.�/_..Width of french------,��F___.___._________ ' 1 Typ"of filter material__s-r__�Q __Depth of filter material______- '______Total length-------------Z4Zt______________________ Seepage Pit: Distance to nearest well__`�_Q._______Distanc m fo ndation___. Q...___.Distancq to nearest lot line.- .......... Y Number of pits_- -------- Lining material- -Size: Diameter____ _3..___.___Depth________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material-----------------____________.._._._. ❑ Size: Diameter--------------------------- ----------Depth--------------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------t----------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line-------------------------:-------------------------------------------- ---------------------------------•------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- \v -----------------------------------------------------•----------•------•---- ----------------------------------------------------------------------------•------------------------------------------------------------------ ----------------------------------------------------------------------------•--------------------------------------------------------------------------------•---------------------------------------------------------------- I I hereb cer+�i� that I have prep4rulafio7nsf this application and that the work will be done in accordance with San Joaquin County ordinances St to la"arLddes and the San Joaquin Local Health District. ---- ___________ ------------------------------ __________________ wrier and/or Contracfor (Signed)------ --- - - ------------------= By:---------------- -------------_--------- - - ----------------------------(Title]---- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ ---------------------------------------- DATE---- —. ' ---------------------- Y REVIEWED BY - ----------T;1_1----------------------------------- ---------------------------------------- DATE--------•------------------------------------ ----------- BUILDINGPERMIT ISSUED----------------------------------------------------------- _---------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--- --------------------------------------------------------•--•------------•-------•-------------------------••------------ __.._______-_.__.._________________________________________________________________________________________________________________________________________________________________________________________________________ A ________._- .-•-i_________________ _. __.__ --- _ _____ _____________________________-_______.________-_-__-__-_________-----_-----_-_-___-_._ FINAL INSPECTION BY:- --: --------------------------------- Date-------- ----------------------------- --------•-•-- 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 r E5.9 REVIBEB B•59 F.P.GG.2M 5-50