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FOR OFFIC J ------------------ ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit -------------------------- ---------- - ----------------- (Complete in Duplicate) ---------------------------------------------------------___.____.__. F,This Permit'Ex ices 1 Year From Date Issued Date.Issued --_-_ i 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. 549.01 r JOB ADDRESS AN�j LOCATI N_/eA I 1:2-0 L Owners Name_____ ��"" - ��.�11 _ E ----------------------------------- � Address-------1�0 ---- . _ I Contractor's Name s f�,/ �-1 -- IIA �1r`----Y---------------------- -----------•-------------------•---------•-----••------ Phone-------------------------- P Installation will serve: Residence 940*"Apartmerit House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . I ' Number of living units:._____ Number of bedrooms j__ Number of baths ./___ Lot size ,9 -�r �.......................... Water Supply: Public system ❑ Community system [T�00,Private ❑ Depth to Water Table; ft, y Character of sail to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ - Clay Loam 0 Clay ❑ Adobe hardpan ❑ Previous Application Made: (If yes,date------______--------) No New Construction: Yes [B-*No ❑ FHA/VA: Yes I' 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----___-^------Distance from foundation----ID______----Material �Cr - /'/ ----------- Noof compartments______ -------------- ----- ---------Capacity--- 0_.------ Disposal Field: Distance-from nearest well..._—-------Distance.from foundation__f0 --------Distance.to nearest lot line_____-_... Number'of lines______' Length of each line__ ry__ � `-' - - - - -J_ g l Width,of trench__.r2 ..;:. Type of filter materiai_ �QPepth of filter material_.___ __-_ V l Total'length---- Z------------------------ \ Seepag Pit: k Distance to nearest well----- Distance om fo ndation----/Q_ :____.D•sstance to nearest lot line_.s� � -___-___- Number of pits_____ ___.___.___Lining material.AD ---Size.Ziameter_'S,3"__..'-__.Depth_o Cesspool: Distance from nearest well-----------------Distance from founder fo --------- Lining material___.__________._______________-_._--. El Size: Diameter-__•--•-------------------------------Depth----•------------------------!--.--------------.--__Liquid Capacity gals. Privy:' Distance from nearest well----------------------------------------------- -Distance from nearest building------------------------------------------ E] ____.____.- --_.-________.__..___.._. ❑ _ _F __w _ �. �.- .....-r -------------------------------------- Distance to-nearest lot'line----------------¢-----�-'""-�'=------------------------------------ Remodeling and/or repairing (describe)-------------- --- o4; 74f. SI5 e4m,--•--I---------=---------•--•--------------------------------- k ,: ------------------------------------------ ---- -------------------------------------- -------------------------------------------------- --------------------------------------_______________________----------------------------------------------_L___._____i___�__-__________-_-_-________-____________.__--_________--___--__-..____-________.._______.____.- y I hereby certify that I have prepared this application and fKa"he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the,San Joaquin Local Health District. t (Signed) - I.-Oex e--- ---- -- -- !�/'�� j, ------- or Contractor) BY: = = l' - ------•---.(Titla)....� 1� ----- ---------- (Plot plan, showing.size of lot, location of sys+em in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �..�- • ti S � ---=--------------------------- DATE ------ APPLICATION ACCEPTED BY_ t - ------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------=--------------------------------------- DATE.------------------------------------------------------------ Alterations and/or recommendations:.___'_ -'.- - - --------------------------------------------•---- --.-------••------------.---------------•-----------•------------- c � ............... ------------------------------------------------------------------------ ------------------- ------------------------------------------------------------------------------------------------------------•- ----------------- -------------------------------------------------------•------------------•----------------•----------------•----------------------------------------------------- --------------------------------------------- i } F1NAL INSPECTION $Y: _4..W-- -- --- --- - a Date "- .. n 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 Manteca,California Tracy,California E9.9 REVISED S-$9 F,P.Cp,;M 6.60