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FOR OFFIC USE: � �_2 ---------------- - -- --------- l17 -- APPLICATION FOR SANITATION PERMIT Permit No. --------- --------------------------------------------------------- (Complete in Duplicate) - This Permit Expires"! Year From Date issued `""""-" Y 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. ' r JOB ADDRESS AND [LOCATION.. ------ j - I=�------;•--------------- ------ ..........................................------•--- &AzOwner's Name------------ - ---------- --------•-••-------...---------------------------------------- -- -- ----- Phone------------------------------------ Address-------- ------------=----•--••--------••--Address-------- 11114100al-- ---- ------ =•--- -------------------------------------------- -------------------------•------------------------------=----------•---------.............. Contractor's Name-----.... •----------------------=-------------------s -------•--.....__.....: Phone.. f Installation will serve: Residence ®-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . A--- Number of baths _ _ Lot size _ v�� / _ .10 Number of living units:._J... Number of bedrooms . ... ... ---I --e......-_-------------------- . Water Supply: Public:system Community system E] Private F1 Depth to Water Table A/69 ft. Character of soil to a depth;qf 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam:❑ Clay Loam ❑ Clay ❑. Adobe @3--F-Iardpan ❑ f Previous Application Made:' (If yes,date__---------_--------I No [R`_New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No RQ__ TYPE OF, INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitfed.i#!public sewer is available within.200 feet.) i Septic Tank:, Distance from nearest well �� _.__Distance from foundation_;'--_ -----------Material----------------_.------------------------------- 4-f -___-_--------___-_--_--. .-No' of comp _____________artments_ - Size..-_-...____________________:_.-Li uiZI depth--------------------------Caacit _ Disposal Fiew: Distance from nearest well... _� Distgance from foundation- -._.Distance to nearest lot line---6---_----- f Nu shot filternmatenal_� De th. off each line_::_ Width of trench__a __.____,_____________________ -/ --- �- yp p __ p "filter materiel--- �_-=_---Total length---- f---_-•----•-_•__-- _-_- Seepage Pit: Distance to nearest well-.----~'_.__---_-Distance,from foundation--&V.s_----_-- Distance to nearest lot Iine_s4v� Number ofits-_-_-_ � p �-------------Lining mate Diameter_��__....__-___--.Depth---a2%jFe_•----•-.---_-•_-- r Cesspool: Distance from nearest well_._.._...___..._Distance from-foiindation__.k ----- - Lining material-------------------------------------- Size: Diameter--------------------------------------Deth--------_--.----_--_�..c k i -Liquid Capacity -----------gals, \ Privy: Distance from nearest well-------------------------------------------------Dist'ance`from dearest building-------------------....................... r — I' V• E ❑ Distance to nearest lot line-- ---- - - -"---------- - ---•--------------- ------------------------------------------------------...-•---------------- - Remodeling and/or repairing (describe):_-___-.-_-' ----=--------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ------- ----------"-------------------------------------------------------------------------------------------------------------------_----------------------------------------------------------------------------------------------- ------------------------------------ p f S I hereby certify-Aat l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulafions of the,San Joaquin Local Health District. ` - ° Contractor)10, ned)-----------------` --- - r Br-------------------------- - ---- - = {Title) _--- ---- (Plot plan, showing size,of lot, location of sysf in relation to wells, buildings, etc., can be placed on reverse side). : FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY___ _ .__-.-._ _ _-_-D"A"TE_~�_ ___-__, __D__�_.lCa. ------------------------ ------------------------ -_ REVIEWED BY------------ g---------------- r ----------------------------------------------`------------------------- DATE BUILDINGPERMIT ISSUED--------- - ------------------ DATE------------------------------------------------------------- Alterations and/or recommendations: . ...__:_ ----------------------------- _ `-_.... - _ ------------------------------------ __ -� „G... .•�.Ip_ V• -------------------•--------------------------- -------------------------------------------------- ----------------------------------------------------- -----_------------ ------------------------------- ----------------- --_- --------------------------------------------------------------- FINAL ! INSPECTION ---- :.:`1-� _ _"-------- .._ , r Dated" SAN JOAQUIN.LOCAL HEALTH DISTRICT_ 130 South American Street 300 West Oak Street "' 124 Sycamore Street--- 205 Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California , E9-9 REVISED 8-E9 F.P.1213.2M 6.613