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rvK,)rri,.r uJt: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.._./�_-��-� � -------------------------------------------------------- (Complete in Duplicate)�(� i -- -------------_ This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.__. _ Owner's Name------- f""-- 4 - -••--- - ------------------------------------- Phone__.-••------•----- � /. ,fit Address Pia..- -•� `''.cam_ lLwt�: r. ---•---------•--------------- Contractor's Name---- -t- - '�� -----=- ----------•-----------------------....--------------- Phone ......................... Installation will serve: Residence ❑ Apartment House E❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 96Y4 -�1 ,� .,..p) Number of living units: ________ Number of bedrooms -------- Number of baths ________ Lot size -------------------------------------------------- __________ .c Water Supply: Public system ❑ Community system ❑ Private ;& Depth to Water Table _¢.._ ft. PART ©ip,-r- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 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 sewer is available within 200 feet.) Septic Tank: Distance from nearest well_/PC7__-+- Distance from foundation_S____(, 'fe_ 13 No. of compartments..._____ Z______________ Size_t.- e' _ _1-1 Liquid depth___ `_1___._.-________ Capacity_Ign ` Disposal Field: Distance from nearest well-10jo `__-__ Distance from foundation__ `i.__...._.Distance to nearest lot line ----------------- Number of lines--------3-----------------------Length of each line -__LOO...._ ---_-__----.Width of trench---,¢•--•------------------ 1 Type of filter mate rial_---------- Depth of filter material___ 191.________Total length --- 3QQ_`_________________________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation___ -------------- Distance to nearest lot line ----------------- F] Number of pits---------------------- Lining material ----------------- ,..__.Size: Diameter ----------------------- Depth --------------------------------- Cesspool: .Distance from nearest well________________ Distance from foundation ------ _----------- Lining material____.-_.________________---____-___ Se'❑ Diameter___________________________ _______Depth_________ _ tt____-Liquid Capacity ___ gals. . Privy: Distance from nearest well ----____________________________�-.-Distance from nearest building._ 5A_______:_____._________.__.___._._. Distance to nearest lot line -------------------------- - ----- ----�----- ,-•----_-- - --. Remodeling and/or repairing(describe):------------------- ------------------------=-------•-•-----------------------•--•----•-••-•------------•------------------------------------- ------------- -- --------------------------------•------------------------------------- r----•-... ------ � -- CF• ` t -------------------------------- ------------•-------- ---• --- -- •-- ----- ---------------------------._...--------- ---------•----------------------------------------------------------- r I hereby certify that I have prepared this application and that.the..work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) T.------------------------------------------ ---------------------------------------- (Owner and/or Contractor) BY:---------------------------- ------- -------•--------------------------------------- - ----------------•----------------- {Title) ------------------------------------------------- .------------- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). x FOR DEPARTMENTdUSE ONLY. APPLICATION ACCEPTED BY------- - -------- ----- ` ------ - _ � DATE ----- 3----- �-�= `� ®----------------------- -- REVIEWEDBY ----------------------------- - -- ------------ ------ ------ DATE ---•-----------•--------••----- --------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- j_ --- :------- DATE ------------------------------ Alterations and/or recommendations•... ------------ _ _0-t4. ____ y Z4Ps -- - r.; - ------ -� -------------------------------------- ----------1-r--- ---------------------------------------------------�-----------...._ - t ------_ --------------------------- --- ---- •---------------------- -----• --- -------------•------------------- ---- ----- ••-------------- - ----;---------••---•-----------------------------•----------------------------- f... ! ---------- --•------------------------------------------•---------•---------------------------------------------- t------'`------------------------------------------------------------- -------------------------- � � � 1 t FINAL INSPECTION BY------------- - ----------------------------------------------- 1 Date-----------------------' w SAN JOAQUIN LOCAL HEALTWDISTRICT 130 South American Street 300 West Oak Street f 124 Sycamore' Street 205 West 9th Street 5 Stockton, California Lodi, California Manteca California Tracy, California t , E5-9 FEVIBE6 e•59 F. 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