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FOR OFFICE USE- -------- ----------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---- -------------- --- ------------------------ ------------ (Complete in Duplicate} `� This Permit Expires 1 Year From Date Issued ' 0 © Date Issued -___-- ----_l.--- - `v -------------------- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and 7install the work herein described. This application is made in compliance with County Ordinance No. 549. 6L ,.�771 S T_ Int a�� JOB ADDRESS AND CATION----- ... �..1 ___ .. .. ..+ Phone.._..-------•----------•-- -------- Owner's Name---- �-�°� ------------------------------ ----------------------------------------•- � h ------- - ------ Address -, -- � -------------------------------- _1------------ ---------- ----------- --------- . Contractor's Name-------- -----• -- -------- Phone.. -Z' Installation will serve: Residence ❑ Apartment House ❑ Commercial )d Trailer CR rt ❑ Motel ❑ Other � , Number of living units: _'©_ Number of bedrooms -------- Number of baths __�___. of size QY+G _ -CLc�r----------------------•`- Water Supply: Public system ❑ Community system ❑ Private * Depth to Water Table .1_1__- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan.C] 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.) t Septic Tank: Distance from nearest wellA-9_0-___Distancejfr,ot�m,rfoundation__ ---------Mat ri i✓'�' C--------------------------- J! -------- ---------------- No. of compartments.---- _______.___---Size„ ?- -I---- -- --Liquid�ydepth--------'�---�---Capacity--.�`-�-----•-- � Disposal Field: Distance from nearest well---1�Q___Distance from foundation.-___?4____.-.Distance to nearest lot Number of lines_____________._- __ .__ _ Len th of each line-10-"".--/-"-.Width of trench._��__-.------------ Type of filter material_5� -_ 9Depth of filter material_-_-_4_.$_____.......Total length____-___//_(7__.____________ ------ 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________..-___._. t~ ❑ dumber of pits----------------------Lining material-----------------------Size: Diameter----•------------------Depth--------------------------------- Cesspooh Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------.. ❑ Size: Diameter---------------------------------- -Depth Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building---------------------------------- C ❑ Distance to nearest lot line---------------- --- ------- - -----------------------------------•--------------------------------------•-------------------� �1 V Remodeling and/or repairing (describe):----_-i-- ~- '' ----------------------------------------------------------• --- - ------- -------- ------------------•--------------------------------------------------------------------------------------•----------------------------------•----------------------------- I hereby certify that I have preparedE tion and that the work will be done in accordance with San Joaquin CountyY ordinances, State laws, and rules and reghe San Joaquin Local Health District. St ned �� --.-------{fir Contractor( -------- - ----- - ---- -- ---- BY: - (Title 1 Aa (Plot plan. showing size of lot, location of ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------- ---- DATE--------------------- --------- 17 REVIEWED BY--------------------------------------------------- --- ` _ DATE % . . f _.,- BUILDINGPERMIT ISSUED-------------------------------------- --• -- -- -------------------------- DATE----------------------------------------------------- ------ Alterationsand/or recommendations------------- ----------------------------------------------------_-------------------------------------------------------------------------------------- ------ -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- -------------: ---------------------------------------------------------------------------------•------------------- ---- -------------------- 4FINAL 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 E9.9 AEVI9Ed 0-59 F.P.C13,2M 6.613