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--------------- --------- ------- �- o APPLICATION FOR SANITATION PERMIT Permit No. .. ........�4 ` [C_.Rht (Complete in Duplicate) -- ------ ---- This Permit Expires 1 Year From Date Issued Date Issued _-______l:`..: '{.'. ,. 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. r JOS ADDRESS AND LR PA ION----- __711—VA- ------- ----•----------- ----------------------------------------------------------------------------------------- Owner's Name %` y --------- Phone------------------------------------ Address J?14 ----------------•- - ------------- --------- Phone................................... Contractor's Name Installation will serve: Residence Apartment House ❑ Cr9 units: mercial E] Trailer Court ❑ Motel [I Other ❑ Number of livin _ j Number of bedrooms __ f Y f-• - - umber of baths L_�, Lot size __�,��,t(__�.4.•�_ __________________________ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date....................7 No �'' New Construction: Yes ❑ No 2- FHA/VA: Yes ❑ No 8^ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S iDtic,Tankr Distance from nearest well-________________Distance from foundation------------------ Material................................................. CK No. of compartments ----------------- -----Size--•------------ -- -------------Liquid depth---------- ----------Capacity-------------•-•--- - Disposal Field: Distance from nearest well__/_j_--.- Distance from foundation-___ ` + -- _�.._-..Distance to nearest lot lines,.etr_._. ..... , y A ------Length of each line-----�_�-`-------------Width of trench--�`-------------------_-..._ fly Number of lines______-___� ______ _ f- Type of filter material..- ( Depth of filter material-__ !!_-----Total length__.__ � Seepa Pit: Distance to nearest well-___1,101"P_-"---..Distance f om fo ndation___.. G!_--___..Distance to nearest lot line-../O ......... Number of pits___-./.............Lining material. -.-Size: Diameter_ __-_---__ • ---------Depth...Ze ------ Cesspool: Distance from nearest well-----------------Distance from foundation---__--_---_____.Lining material__-_____---.___-----_-_ ❑ Size: Diameter--------------------- -------------- Depth------- ----- ------ --- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well............-_--------------------- -.._Distance from nearest building ❑ Distance to nearest lot Sine. 1 Remodeling and/or repairing (describe):--------- ------- ---- -------------------------------------------------------------------------------------------------------------------------------------------- --- Z ------------•- ---------- -----------------------•-------------- -----------------•--------------------------------------•---------------------------------------------------------------------------........ hereby certify that I have prepared this application and that Ae. 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)., i .-.�4 � ��`� __ _ _ Qr Contractor) By:_---------- f- 1_ (Title) � Vj44_.:' ----- - --- z a (Plot plan, showing size of lot, loco+ion of sys+Ani i rele+ion to wells, buildings, etc., can be placed on reverse... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- C..-.-;3� ..------- --------------------------------- _ Z ----------------- ------ DATE...---------------�--`.�-:3,-•----- -------- REVIEWED BY-------------`--- ----------------- : -- DATE-- ATE-- BUILDING ------------- ----•� ----------�--- � t PERMIT ISSUED ---- - ----- -rte- ---- -- -Zk -- - --m--�-�---...---�---- ----�--� --�----- DATE Alterations and/or recommendations- ___J -__.4 .-._ l " ! c (-------•----------' -- -------------------------------------------------------- rs_------------------ k ma ..... FINAL INSPECTION BY:---.C. - Date-..., SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wed 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8-89 2M 5-61 ASLAS