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APPLICATION FOR SANITATION PERMIT Permit No. ....../!..(.f.3... (Complete-in. Duplicate)- ' = This Permit Expires 1 Year From Date Issued = Date Issued _1__— _ 6 6 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 complianceh County Ordinance No. 549. � � JOB ADDRESS D LOCATION------_ __I__ 1�T�P Owner's Name---- -- ------------------------------------- Phone------------------------------- Address------------ ?_.� - Contractor's Name-----i----------------------------------------------------------------------- ------------ -----------••--- Phone............................ Installation will serve: .Residence M�_ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ I �7 �, Number of living units: __-___ Number of bedrooms __Number of baths -__`___ Lot size ___ _ _.�. } _____________________ Water Supply: Public'system K Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of-soil to a 'depth of 3 feet: Sand {Gravel ❑ Sandy Loam J�5 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nom New.Construction: Yes ❑ No N_ FHA/VA: Yes ❑ No TYPE: OF INSTALLATION AND-SPECIFICATIONS: • {No septic tank'or cesspool permitted'if.public sewer.is available within 200 feet.} � Septic Tank: Distance from 'nearest-well__S-_-Distance from fobn r ir>n__: �_ -------.M ial____,__._._ No. of compartments . SizeLiquid de th_ CapacitY••- - �_1C. _. t Disposal Field: Distance from nearest�well_j�,_:-._Distan froy�fo a i rl..-'[. .—.Distance to nearest lot line___ ___.-_-_- [�. Number of lines-. - _______Lengf ioi eabc i ii line_ �--� ��t��__�.Width of french.-- -------------------------- it , Type of filter material--- Depth of filter material____. g JOU YP p `-��---- _--.Total len th___-- 1 Seepage Pit: Distance to nearest well---------------------- from foundation...._.:__':------Distance to nearest lot line_________-_-._. 5 ❑ Number of pits----------------------Lining material-------------'---,---_Size: Diameter-----------------------Depth------------------------- _------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-________-__________--_--._________ ❑_ Size: Diameter------ --I---'------------------------Depth--------------- -y=�~ Liquid Capacity_--------------------------gals. _ Z- �:r Privy: Distance from nearest wel--------------------------_________________ _'._Distance from nearest bui4ding.________-_------_-._______-________- Distanceto nearest.lot line-----------------------------------------`-------------------------------------------------------------------- ------------------------------ Remodelingand/or repairing (describe):-`---------------------------=------- ------•----- -------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ---------------------------- -. I:hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,,State I 'r and rules and regulations of the San Joaquin Local Health District. ( 9 ) ........... ------------------------(Owner and/or Contractor) -1� ---------------------Title-------------------- -- ------- - - ---------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTI D BY - -------- �_ / DATE r-I° ll� REVIEWED BY = ---------------------- ------- DATE-------- V` BUILDINGPERMIT ISSUED------- --------------------------------------------------------------------------------------------- DATE--------------•-------------------------------------------- Alterations and/or recommendations:---*-------------------------------------------------------------------------------------- -- __ ------------------------------------------------- }J-T }31�?"1Q 1--------. l o:rrm �----0914_ 3 _C4,e _E # --------------------------------..,�^y,.�'`.,re-M1-- - ------RUTf-------PRJO BEit>----- tov.C-114 rata . a;,- ------------------•-- - ----------------------------------------------------------- ----- - _E ---- •--------------------------- - ---------------- ----- I ------ ---------- ---- -------- :."---------- --- - ---- ------------------------ -------- , FINAL INSPECTICtf1 B�f:.------ ---- .- - -------- Date------ --....._ ...._ s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M j„ Revised V59 F,P,Cc.