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FOR OFFICE USE: l/ ___._-__________________________________--------_____ APPLICATION FOR SANITATION PERMIT Permit No. _-f_----- L- --------------------------------------- ----------------- (Complete in Duplicate) ------------------------- This Permit-Expires 1 Year From Date Issued Date Issued _______________________ 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. JOB ADDRESS AND LOCATION... -_--.---A* - ------------------------------- Owner's Name----- / - ................... --------------------'----- ------------------------------------------- Phone------------------------------------ Address----- CG ----- ---•- ----- r t� [ Contractor's Name------------- -- -------------------------------------1........... Phone......`}.. -------- Installation will serve: Residence [}'_Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f 10 Number of living units: __j___ Number of bedrooms . __ Number of baths jAn__ Lot size -________________________-_ Water Supply: Public system ❑ Community 'system 'Private ❑_ Depth'to•'Vi�'�aft, Table Character-of soil to a dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er"Hardpan ❑ r' Previous Application Made: (if yes,date-------------- I No Rr—New Construction: Yes Er—No ❑ FHA/VA: Yes 23-� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 .feet.. �•, (,� Septic T k: Distance from nearest welf-------------Distance from foundation____l�______ Material---�-(l-�_� ----- ----------- No.-of compartments-.. ------- Liquid depth-_. --- -----------Capacity--,lid------- Disposal Field: Distance from nearest well.- -------- from foundation...-/e Distance to nearest lot line__�1__.l.._.___ ...................Number of lines_____-------------------------.Length of each line_"X�_yf_'_-_!____.Width of #ranch--- Type of filter material- Depth of filter material___ T_ff----------Total length_ __________ ------- Seepage Pit: Distance to nearest'well------^_^°--------Distance from foundation___ 11.r...._..Distance to nearest lot line-_ �____.- Q i/ P y. 0� Number of pits______ ______________Lining material---1P._ ----_----Size: D.iameter_v� ---__________.De th._ __-______________.___ Cessp❑ Size: Diameter•------------- , ool: Distance from nearest well________________DDesttahnce from foundatin_--:_._____________:Lining material___.____--_.---_-______________---___. p __-_Liquid Capacity---------------------------gals. � Privy: Distance from nearest well------------------------------------------(______Distance from nearest building---------- '`---, =------------------------ ❑ _ r Distance to nearest'lot-line'_-.----- - -----------=- --------------------------------------- = - z r -------------------------------- ,Remodeling and/or repairing (describe):--------71.eW/_,.,4�!_ P ---•-----•--•-•-------••--------------------------- --- -------------- ti l=`-- --------------------------------------------------------------------------------------•--•-----------------------------=----•-•------••--------------- =` hereby certify that I-have'prepared this application and that the work will be done in accordance with San Joaquin County �ordinarices, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------- --- --t- -------- \------------- --------------------------- ----------------•--_(QwRepoeft�Vor Contractor) BY:-------------------------------------------------- 4W�i, --------="--------- ----(Title)------ �-------------- ------------- ti.. (Plat plan, showing size of lot, location'of.syslation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ DATE_ �' ' rte' ------------- ----- `C� l REVIEWED BY ----- -------.---.--L - DATE ` BUILDING PERMIT ISSUED-----,7------------------------------------- ------ DATE-----------, --------------- Alterations and/or recammendatians:_ =--------------- ----------------------------•-•-----------------•---...------•------`----------------•--=---------------...----------- ----7 ----- -----------•--------------------• ------------------------•• ------------..-----------------------••-----------••------------- --- --------- ---------- -- , .�- -----------------•-••---------------------------•---------•-------------•--------• -------------------•-•--------------- ----------- "-----------------------•... I -! FINAL INSPECTION BY:._ .. _ .- _ --- ` Date........ ----- SAN JOAQUIiV LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California E9.9 RevisEc a-59 F.FX13.2M 6.60 f '