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SE:-- FOR OFFICE USE- --------------------------------------------------------- I ------------------------------------------------------- ! 4 $S _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ------------------- ----------------- (Complete in Duplicate) -:="" This Permit Expires 1 Year From Date Issued - -Date Issued `___`_________________ Application is hereby made +o the San Joaquin Local Healfh 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--A_!�. Owner's Nam�fo? -------------------�.., Ph------- -----------••------------------------------ one---------•------------------------- Address---....--- ' --------------------------------------------------------.......... Contractor's Nam- e----____.. f •---•------------•--- Phone----------------------------------- Installation will serve: Residence KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'Number of livingunits. _ i �___ Number of bedroom`s %__ :Number of baths Lot sizef z e-------------------•---_--_-- Water Supply: Public systerin. ❑ Community system ❑ Private ❑ Depth to Water Table _;Yft. ' Character-of soil to,a depth of 3 feet: Sand ❑.G Gravel ❑ Sandy Loam [] Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- -----) No ❑ 'New Construcfion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted.if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,_•:—_----Distance from foundation__/41)__--/41) Mate ial__ r_(�- �� No. of compartments-----A------ �/ -- - Size_ __�� ' ' ------ ---- ,�-[��fr--Liquid depth--={---9�-� --------Capacity.��47-----.. fDisposal F' Id'. Distance from nearest well: ---- ----------_.Distance from foundaption-__ Qr-----Distance to nearest lot line_-_�_d__7/.___ Number of lines-- --------- - -----------Length of each fine-4-��, Width of trench--- =•�_--- -' p,, // ---------- Type of,filter material�/��1'CJ Depth of filter material----��`�:_._Tofial len th_--� .Q t Seepage Pit: Distance to nearest well----------------------Distance from foundation__________________-Distance,fo nearest lot line--------_----__. ❑ Number'"f p':its--------�-------------Lining material-----------------------Size: Diameter---------------- ------Depth-------------------- Cesspool: Distance from nearest weil-----------------Distance from foundation---------------------Lining material_-_-___---____________ ❑ Size: Diameter--------2------------------------------Depth--------------------------------------------- _.-Liquid Liquid Capacity------------•--------------gals. Privy:t Distancefromnearest well__________________ ___.----------------------------Distance from nearest building F1 Distance to nearesfdof line-------------- ----------------------------------------- Remodeling and/or repa: n;9 describeJ :__.___________- --------------------------------------•------------:-------------------------------------------------------------------= I hereby cer+ify that I have prepared this application and'+hat the work-will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dis+rict. (Signed)-, --- -��" '° ------------------- -- ----------------•---------------•------------------------- - --( Contractor) BY: ----•--------------- ( � e) ------ (Plot ---- s. (Plot plan, showing size of lot, location of sys+ to relation to wells, buildings, etc., can be placed on reverse side). 1 .) ,,.,- �"' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ REVIEWED 3Y-- " 'Rs-------- ------------------------=--- ----------------------------- DATE_:.-. _S _ ----------------- ------------------------ -------==--•-----: --------- --- DATE BUILDING PERMIT ISSUED.---------•-- f <--------------=='=--•--•-------------------------------------------------------- DATE-------------------- ` ------------------------------------ Alterations and/or recommendations:_________________ _ % --,--------------------------••----------•-----------••------------•- 1 -•-•----••-------•------------- ,, ---------- -- -------------- ----------------------------•--- •----------------- - ------------------- ----- --`-------------------- ! - - - -- ---- ------------- --- - --- --- -- E ------� j-•-----------��-----•- FINAL INSPECTTOAIY:-- --! --- - -•- bate__-- 1�` f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteea,California + Tracy,California E9.9 REVISEo a-S9 r.P.c D,7M 6-So -