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FOR•.)FFICE USE: '------------------------------------ ---•------------ Permit No. APPLICATION FOR SANITATION PERMIT .._��..__ti_�J -------------•------------------------------------•----- (Complete in Duplicate) /4 ,r -.._------------------- ---___.....__._____--___._._ This Permit Exaires 1 Year From Date Issued - Date ..........� Issued __. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. k p� JOB ADDRESS AND LO ION--ar4' •�� r °----------------•-•--------------------------------------------------........................ .. Owner's_Name pp -• -• Phone---------------- ------------•— Addr --------------- ------ --•------------... ... Contractor's Name-------------- --- - --- - ------------------------------------ --•---•-- - ................... Phone................................... i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---Z. Number of bedrooms Number of baths .t?-r Lot size f `^v..�..��•t/................ ` Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table Ax0 ft. 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 g?" New Construction: Yes @3'No ❑ FHA/VA: Yes ®--No ❑ TYPE ,OF INSTALLATION AND SPECIFICATIONS: , �(Na septic tank or cesspool permitted if public sewer is available within 200 feet.) a �p� Septic Tank: Distance from nearest wel_____` ___.Distance from foundation- _ _________.Mat Material .....�-� '_._._..._.. No. of compartments_._ --------------- Sizex��_Xti --X iquid depth_...- -- Capacityj1 ...��---- Disposal Field: Distance from neares ,well----- '__--.-Distance from foundatia�-.6Q--__-_---Distance to nearest lIf ot line...1�_....... Number of lines...... .......... _._ _Length of each line_ ,___________._.-____..Width of trench__.r _._.-_...-_._________....... M-- - -------- .. i Type of filter material./��ri� rDepth of filter material__.l4P _______._.Total length....>>. ........................ Se�' 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--_____--_-______--__-----__-_--_-___ r Sizer Diameter-. ` ' "1-----------------------Depth--------------.-a--- ----=--•----=-----------------Liquid Capacity................---_-- -gals. Privy:if Distance from nearest well-------_-----------------------------------------Distance from nearest building--'.................... I ❑ Distance to nearest lot line .........................-••------•--••---••----•-•-----..-.-----------------•-- Remodelingand/or repairing (describe):_ -�--------------------------------- •--------------••--•--•---------------------------------------•---_---... ---••--------•--------------• r , I i ------------------------ ________________________________________________________________________ _________ _ _---------------------------------.----------------------------------------------.......... 3 ____________________________________________11_____________________------------------ 1'hereby-certify that I have prepared this application and ,-that the work will'be done in•a=-6-rdance-with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. t� �. - - - � (Signed). ----'�-_..----- Contractor) !/ f ,4 (Plot plan, showing size of lot, location of system ` at on +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED i3Y---- C t DATE_..-,t { REVIEWEDBY----------••---------------------------------------- - -__. = - _::---=-------------------------= ----------•--DATE...-----.._....------------- J------------------------ BUILDING PERMIT ISSUED---------------------------------------- ----------------- --="------------------- -- DATE , AFterations and/or recommendations:..-t'-------1.�.S-i��i+�a-v+--------------- -------teLA- .__... ------- ._-••---- ---�ZI&C ...Q -------Lea -------iso- ,�.�,,O.e +ems�------------- ------ .......................°-....A r� ----------- 1 , ...........i---------------------------------------------------------------------- ..._-. - FINAL—INSPECTION�BY:==.C_-.__` : . -------`-::----------- ------ ----- ----------------------------- SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Strout t � 300 Wast Oak Street 124 Sycamore Street 205 West 9th Strout Stockton,California Lodi,California Manteca,California Tracy,California 40 9 REVISED 8-59 pM 8-61 ATIAS