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"�r R OFFICE USE: -- ---- ----- ---- r APPLICATION FOR SANITATION PERMIT Permit No. _._...... . - -- --------------------------------------------------- -- (Complete Y Duplicate) � This PermitExpires1 Year From Date Issued E Date Issued p�Vdji (ee2o U�{erO Application is hereby made to the San Joaquin Local Health District for a permws� to c nstruct an 1 stale work he ei d sorbed. This application is made in to with County Ordinance No. 549. a LV- P 1`I.Z.-�,jd© 9- f-f 1�c�+�- r , t JOB ADDRESS AND L A�IONXi�,__/- &1Y�I15- �--- ---- ----------- ------- ----- ----- ' Owner's Name---- - - --------------- Phone.f7 -ag --- Address-----------------------•Cle . ...-'-- .)----------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-------:----19 -- ------- -----------------•------------•--- ------------------------------•---•-----Phone V 7----- Installation will serve: Residence Y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _----- Number of bedrooms _s__- Number of baths j-_._ Lot size _________________________ Water Supply: Public system ❑ Community system ❑ Private;d Depth to Water Table .60. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe'R Hardpan ❑ Previous Application Made: (If yes,date____________________) No M New Construction: Yes ❑ No JX FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: -A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ----_-----.---.--.------------------------------ -- No. No. of compartments------------------ ---l-Size-----------------------•--------Liquid depth---------- ----- -------- Capacity----------------------- Disposal --------- -----------Disposal Fiel - Distance from nearest well Distance from foundation__. _ Distance to nearest lot line._._s .....+` Number of lines-----------1-_--_� __Length of each line___. ._ Width of trench------------ _ ...._.. �ttQ Type of_filter material___rL0,C_-K-___Depth of filter material_"" ___Total length---------------------- .�`, 1 1, Seepage Pit: Distance to nearest well---/QO--.�.---Distance from foundation---- �--___.Distance to nearest lot I'ne_1 Number of pits------r_____________Lining materia1_20& -Size: Diameter-----vote-----.-__:.Depth--------- .5-------------� Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material---------_------.--.----_-_-------.-- Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity-. l Privy: Distance from nearest well----------------- -------------------Distance from nearest buiidin ❑ Distance to nearest lot line--------- --------------------- ------------•---------•-----•----------------•----------------------- -------------------------------- Remodeling and/or repairing (describe: - - Y S T� i . --------------------------------------=-----------=------------------------------- ------------------------------------- ! - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,' and rules and regulations of the San Joaquin Local Health District. (Signed)------------- -r-------------------------- i-..------------------------=---------------------.(Owner and/or Contractor) } f ° By:--------- ---eelc ----------------------------------=---------(Title)-- t .......... .......----------------- (Piot plan, showing size of lot, location of s+em in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = DATE 'ZC------- REVIEWEDBY------------------------------------- ---------------------------1-1----------------- ---------------------------------- DATE----------------- BUILDINGPERMIT ISSUED--=--------------------------------------------------------- —-------------------------------------- DATE.------------------------ ---------- ------ Alterations and/or recommendations:------ ------- --- ------- - ----------- ----------------------------- , -4 f C? .........--ee---------------------•-----------------------------------.._---------------------------------------------------- :------- ------------------------------:------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- ------------------------------•------- ---------------------------------- ----------------------------- -- ---. . A �. Date.---- � - --- - - •- - ---- FINAL INSPECTION BY:.____._... _°_.A.-r_� ------ a �� - i-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'63 F.P.CO.