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FOR OFFICE USE: -------- 1-4t--- 9 �- -------------------- ---------------------------- ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...�� ---------------------•• -----------------••---------- (Complete in Duplicate) This Permit Ex fres i Year From Date Issued Date Issued ..1� .. 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. /427 JOB ADDRESS AND LOCATION__-: ------- __ , _-_••- . -------------•---•--- _• -•-•--..._. Owner's Name------------- �! � :��...c7411_ Z9. Phone,i -- Address-----------•---_------- / Zr��-?' l� jr Al, -�. -, r� —------------ .....r_. *— �--------------- Phone, Contractor's Namel__ _.______ tel. Installation will serve: Residence g6 Apartment House ❑ Commercial ❑ Trailer Court Motel Other Number of living units: 1..___ Number of bedrooms AL�'Number of baths .... Lot size _.. ?C - _____________ Water Supply: Public system;K1 Community system ❑ Private ❑ Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,' , Hardpan ❑ �At Previous Application Made: ilf.yes,date--------------------) No '❑ New Construction: Yes ❑ No,?t FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Ccf septic—tank-or cesspool permitted if public sewer is available within 200 feet.) i Distance from nearest well_________________Distance from foundation-_._.-_________-- Material____-____________-._.-.-.._.No. of compartments•-------------------------Size-..--•--------------------------Liquid deRt�--.._._..---------------Capacity-----------••-•-•-•Distance from neare t well_�OAe.._Distance from foundation..4,� __Distance to nearest lot line___-- Number of lines_________ __ i ��------ - -- -- Length of each line----------____-- rf Width of trench- ------.--- Type of filter material.__. f_1 (__.___Depth of filter material..L_�________-•._Total length..--------1.:;S----00................ ag e Distance to nearest well__ _._�t._�_ .Distance from foundation___ 1 _.__.___.Dlstanc�to nearest lot line...s��..__.__._ �► d Number of pits_____ _______________Lining material., Size: Diameter-__. Depth.- .e. v --------- Cesspool: -Distance❑ from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------_ Size: Diameter------------•--- --------------------Depth---------------------------------------------------.-Liquid Capacity -----•------------------- -gals. Privy: Distancb from nearest well ______________ --------------•--------------___--Distance from nearest building-------------------•---------------•----•. • ❑ Distance to.nearest lot line----------------------------- -------------------•------------------- - Remodeling and/or repairing [describe): ------••- --..... •-----------••----•-------------•-- T - •----------•-- ----- ';: - -- - - - hereby certify that'I have prepared this application and that the or will be done in accordance with San Joaquin County's ordinanqStagylaw d rules and re lations of the San Joaquin Local Health District. (Signed)... _ --------------------------------- BY= ----------------••----------------------- ------ t -}----- ------(Title)-------------------------- (Plot plan, showing size of lot, location of system in re In to wells, buildings, c can be placed on reverse side). DEPARTMENT US5 ONLY APPLICATION ACCEPTED BY.------- -- s ,....__� DATE ,�f`,� = REVIEWEDBY.. ----•••----f---- ------- -------------- •------------------------ DATE----------------------------- BUILDING PERMIT ISSUED-------- -----------••----•-•---------------------------------------•--- ------------- --------- DATE Alterationsand/or recommen ations:-------------------------- ----------------------------------------------•---•--•--------------------------------------....---------------------•-------------- -------------------------------- •_.-...- = ............ ------•----------------'------- ------------------------------------ ------ •-------------------------------- .-----------------------•------ -------------------------- --------- •--------------------- --------------- -------------------- ........--------------------------------.... ---------------- _...._ r FINAL INSPECTION BY:...---"-------- ------------------------------------- --------- Date------- ---------- SAN ---- 1 (4 ga SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stocktonr California Lodl,California Manteca,California Tracy,California EB 9 REVISED 8-99 2M 3-61 AILAB