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FOR OFFICE USE: �--.- . . -- _ -_--•- _-- - - ---------------------- -- ---- APPLICATION FOR SANITATION PERMIT Permit No. ..•-•---......,---..... (Complete in Duplicate) w f - -- " 'This Permit'Expires 1 Year From Date Issued F 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 compliance with County Ordinance No. 549. F p ` JOB ADDRESS AND--LO ATION-. � .-- t _--: -- - •----------------- I Owner's Name--------- -------- Phone-------------- -----•---••---....... Address - - ---- --------- Contractor's -------Contractor s Name--• - ------------- -------------------------•--------__. ------ Phone..........................`---- - Installation will serve: Residence [R`-'*Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-. Number of bedroom5S-___ Number of baths Lot size 04 0 __________________________.__-- Water Supply: Public'system ❑ Community system ❑ Private ff Depth to Water Table 10_Ift. Character of soil to a depth of 33 f�eet—Sand;❑._. Gravel ❑ Sandy-Loam [:] Clay Loam E] Clay ❑ Adobe ardpan El [ ?�• �� Previous Application Made: (If yes,date-------- _.__--I ' No New Construction: Yes 01"No ❑ FHA/VA..-Yes K---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 a-_-_. _:D'sta c from fFundateon----r4.9----------Material___ �C` .................... No. of compartments--->—?----------------Siz _.____ ,S`c� 4fQ.Li uid de.th !_ _. . q p --------Capacity,,�xo� Disposal Fi Id:_., Distance from nearest'well � ^ :.Distance from foundation___,�j...._.__Distance to nearest lot Ili Number of-lines--104 j Length of each line__�r�'`. _`--______.Width of trench__�� —_ __________________ Type of:filter material,/-i _- _ � -Depth of filter rriate-rial____- -------Total length_ ------------_________._ , Seepage Pit: Distance to nearest��w9ell_._lwr__.____:Distance from fa}��JnJdation___11��______.DistF6ce to nearest lot lin A�`P-_ Number of'pits------�---.-__----Lining material--/p{f!�/--_-Size: Diamete r_Js'------------Depfh- a-r-.--•------------- - IIf Cess❑ool: Size Diameter neares# waif Depth-- --_-_ sundation-------------------Lining material.-------------------.--_------------_. I p Distance from foundation ----- --------------------------Liquid Capacity----------------------------gals, k Privy: Distance from nearest well_________._�_..____________________________Distance from nearest build•:ng------------------------------------------ El -__________________---__ ___. ❑ _.� - . .., �.. .._ ` Distance'th'nearest�lot line--'�------�s-----t'-----�--------- ------ ••------------------• --•-------------------- ----•-------------• Remodeling and/or repairing (describe):_:----- ---------------------------------------------------------- ill •-•-------- - -•----------• ------ _____k ________a___------------------------------------------ --; _______ _ -------------------------•------- -------------- ------------ ----------------------------------- -- ----------------------------------------•------- , ------------- ------- ---------------------------•--= ----------- -------------•--------------------------------- 1 hereby certify that I have prepared this application and t at--the work'will'be done.in accordance with San Joaquin County ordinances, State laws, and rules,and regulations of the Sawn Joaquin'Local-Health District (Signed) ------- Contractor) u. g Y - ---- ------=-------------•------------(Title)----�+/��---------------- (Piot plan, showing size of lot, location o tem in relation to wells, buildings,.etc., can be placed on reverse side). s�--, OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY6. - I h- - --tea �� -- DATE-------- -DATE -- -- ----------- R'EVtEWED BY--- ------- ... r - _ .�..=.'DATE BUILDING PERMIT ISSUED.--•-- --Ael--- --- ---- - . . ,- AT Alterations and/or recommendatio s:,L_•4, yam __ '. !mel, -----------:--------------------- ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ -----------------------------___-----_--------------------_______;_ ...`. �, ----------------------- _____ _ ______. _____-__-__________________-._--__-- FINAL INSPECTIONBY::- = .� f - '>`.=- - " Date-- - ------------ �1L1.__' V--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300.West Oak Street i 124 Sycamore Street— ;� 205 West 9th Street Stockton,California Lodi,'Coliforniei � _i Man16m CaliFornla'� Tracy,California 4 E6.9 REVISRD 8-39 F.P.Ca.2m 6.6E1