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FOR OFF!g USF,., --- --------- -- - ------•-----.------ -- ....... APPLICATION FOR SANITATION PERMIT Permit No. .._._'... __-...w..... � -- --42_1-0- - (Complete in Du � ' -- ( p plica#e) ___----- -- -- This Permit Expires 1 Year From Date Issued Date Issued _____--------____4.___ 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 LOC TION----- 71 ---- ------------- ----- -----------•-----•--------------------------- Owner's Name------------- • - --- ------------------ Phone---------------------•-------------- Address____-_----44W1'•- Contractor's Name • ------ --------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms,.7---- Number of baths .21.- Lot size , - ----------------------- Water Supply: Public system ❑ Community system ❑ Private R�<epth to Water Table left. Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W?-77-ardpan ❑ Previous Application Made: (if yes,date... ----- ,--------) No R---New Construction: Yes ❑ No RD FHA/VA: Yes Flo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S?P••tic Tank:, Distance from nearest well__________ ____Distance from foundation--------------.__._.Material.__._._.______._...._.___._._____..__...._ G X�Stl"� No. of compartments------ -----------------Size----------------------------•_Liquid depth----------_- - ---------Capacity----------------------- Disposal Field: Distance from nearest well__-"--.Distance from foundation__/&4 r — ,,�- _ . ___.____.Distance to nearest lot line____...-.___ „�-; '��y Number of lines----___. •--- -- Length of each line-------yr _-----_-_.Width of trench-.� ----------------------- v /, Type of filter material � Depth of filter materia!_. ] ' ___Total length__-_- -�_ ------------------- U Seepage Pit: Distance to nearest well.... ............._Distance from foundation--------.----------.Distance to nearest lot line-------.-__._-.-_ ❑ Number of pits----------- ------Lining material----------.------------Size: Diameter---_---.. - _ ---Depth--------------------------------- \j Cesspool; Distance from nearest wel ---Distance from foundation____________________Lining material----------------_------- V ❑ Size: Diameter. ---------- --- ------_---- ----Depth_..._..- ----- ------------- -------------- --- Liquid Capacity-- -------------- ---------gals, Privy: Distance from nearest well................. ---------Distance from nearest building ❑ Distance to nearest lot line ____ - -------------------------- "awl, Remodelirg and/or repairing (describe)=- - -- ---------- G _- - ------------------------- ------------------------------------------------------------------------------- ------------------------------------------- ------------ %----------------------------------•--- ------ ------- ------- ------ ------- ----------------------------------------------------------------------------------------------------------------------------------------------Z I hereby certify that I have prepared this application and that the work will be done in accordance with i& Joaquin County ordinances, State laws, and rules Ind regulations of the San Joaquin Local Health District. (Signed)--------------------- - - O By: _ . Tt#Ie r Con#rata-- -- �- ---------- ( � ) )(Plot plan, showing size of lot, location of system in relatio es, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._ " " --. .--- ------------- --------------- DATE__ REVIEWED BY--------------------------------------- ------ ------ DATE--------- BUILDING PERMIT ISSUED------------- ----------------------------------------- -- -••-- - ----------- ._ DATE-------------- Alterations and/or recommendations------.------ ----------------------------- -- ------------------------------ - -------- - ------ -------- .---- -/__- -- V! , •-------------------- ---------- •-------•-------------------...-------------------------------- ----- --- ------------------ . --------- -------- -------- 1:�-. FINAL INSPECTION BYE' l.._ r�*Lr :�J Date.. �J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California Manteca,California 205 West 9th Street Tracy,California E9.9 nEVI$Ep 9.59 F.P,p p.2M 5-60