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FOR OFFICE USE: 51 __ ... APPLICATION FOR SANITATION PERMIT Permit No. -� -��-•--s-�-- - -------------------------------------------------------- w ` --------- ------------------------------ --------------- (Complete in Duplicate) Date Issued ------------------LA This Permit Expires II Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO TION..I/ - /� l- - F - '1 Address----- � Phone Owner's Name------GUZ_ .At------------- •--------- ----------------•-----•------•-----•------•--•--- -- ------- - ---- •� � --------- ------------•------------------------------------------------------------------ Contractor's Name---- 1 1 .�-� . '�.. Phone •... Installation will serve: ResidencR_Q Apartmea# Hous❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: )__. -_ Number of edroom�--- Number of baths ________ Lot size --------------________-------____-_-_--____-__-_____---- Water Supply: Public system ❑ Community system ❑ Private J� Depth to Water Table Vit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {1f yes,dote-----------_---- __) Noj� New Construction: Yes J4 No ❑ FHA/VA: Yes ❑ Nn l TYPE OF INSTALLATION AND SPECIFICATIONS: (No Se rti n septic tank or cesspool permitted if public sewer is available within 200 feet.) p Distance from nearest well_�Qn__Distance from foundation--_ - _-___ - Material__________________.________..------------------- No.—of compartments compartments--------------------------Size__-. -------•-------------- ---Liquid depth----------- --------------Capacity----------- may., tsposal Fiel Distance from nearest well.!IIs-_Distance from foundation__. �-.Q istance to nearest lot lin ❑ Number of lines___ __Length of each line..-Q- }--S___Width of trench______ie4-- -=--------------- ------ ---------- - - Type of filter mater ial---Depth of filter material--,&--��-----__Total length �~�___________________ Seepage Pit: Distance to nearest well-------------------___Distance from foundation--------------------Distance to nearest lot line_____.__•._-__._. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- m _Size: Diameter. Depth-----------------------------------�------- -------Liquid Capacity----------------------------gals. C Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------- ElDistance to nearest lot line.----- ----------------- ----------------------------------------•----- •----- --------------------------------------------------------------- Remodeling and/or repairing (describe)-----------------------------------------------•-------A--------------•------------------ ----•--------------•---------------------_-............... f------- -- ---------••-------------- ------- ----- ------------------------------------ - ------------------------•------------------------- ------------------------------------- I hereby cer�if�iir that I have preparA thi; application and that the work will be done in accordance with San Joaquin County ordinances, Sate laws, d rules - regulatibriso f the. an'Joaquin Local Health District. d ----- __"le- (/ ------------------------------------- (Signe ___________________________[Owner and/or Contractor) ) - Title g P } (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------- ---------------------------------------- DATE------------------------- ------ REVIEWEDBY------------------------------------------------------------------- DATE ._ r _ BUILDING PERMIT ISSUED---------------------------------- -- -- DATE---------------- ----------------=----- Alt ratios and/or recommendations;______.._ - ---------- ---- ---------------- ------------ .------------." --- ---------------------------------------------------- ---------------- - - -- ------- r►�-, ------ ----------------------- ------------------ -------------------------------------------- ----------------------- ----- 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 E9-9 REVISED 0.69 F.P.EO.2M 6.60