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FOR OFFICE ISE: Y -_____-------------___-----___--- APPLICATION FOR SANITATION PERMIT Permit No. ...f . (Complete in Duplicate) ��jo�(� / �_ Date Issued ________ _____l-- .................. ... .. . ----- This Permit Expires 1 Year From 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 LOCATIO -�A .----••-----=----•-•--•-----•-•---•-----------••--••-••-----•--•---------•---•--- Owner's Name---- -- .... -----------------.............................................. ---------------------------------------- Phone.................................... Address.............- 'pl . Contractor's Name --- --- -- � :.. ....... Phone.............. --- ---� Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __-- Number of bedrooms .-- --. Number of baths _f-._- Lot size ............................................................ Water Supply: Public system E `ommunity system ❑ Private ❑ Depth to Water Table-�!. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f--kardpan ❑ j Previous Application Made: (If yes,date-------------- No New Construction: Yes Er"N--o ❑ FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: h Distance from nearest well-----------------Distance from foundation....................Material------------------------------------------------- / No. of compartments--------------------------Size--------------------- ----------Liquid depth------------------------.-Capacity....................... Disposal Field: Distance from nearest wel,I,;,,rr�,-e...Distance from foundation -!:�..._....-__.Distance to nearest lot line-_42 (� Number of lines----------I--._-.._-_--�-_-_-__Length of each line------ ...__-�.......-----Width of trench._-o Y•..................... Q� Type of filter material--`?Aa.._-_---.--Depth of filter material.....___._&F.�"--.--.Total length...._..•�............................. Seepage Pit. Distance to nearest well_, 1c -._._Distance from foyndation_1�+t+r*n...Distance to nearest lot lines_, r yr J [1J� Number of pits.--.�..._.----__-__-Lining materia C_ __Size: Diameter-_...311.."_.-._.-Depth_..Z►-S-'............. r ' 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 line---------------------------------- ----------------------•------------------------------•-•------•--------•--•-------------------------------- i Remodeling and/or repairing (describe :-------------------- -- --------------------•-------------------------------------------•-----------------••------------••---------------------------- ---------------------------- -------------------------------------- •--------- -----------------------------•------------------------•-----------•--------------•----------------•----------------- I hereby certify that I have prepared this app i son d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ulations he Joaquin ocal Health District. (Signed)---------------------------------------------------------------- ------ ---- - ---- ------- -------------------------------------------------------------(Owner and/or Contractor) By:........................................-- ------- --------- -- ------- --------------•-----------------------(Title)---------- ------------------------•------------ -------------- (Plot plan, showing size of lot, location of system ' relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- - --------------------------------------------------- DATE = -y6 V-------------------------- REVIEWEDBY-------------------------------- ------------- --•--• DATE............................................................ BUILDING PERMIT ISSUED-------------------- DATE...... ------------------------:---------------.------ Altera ions and/or recommendations C-4 - vet 7e-------------------- �_ .__ f. 5� A ................. ------------ . ..... cIZ.V'-Z-...C J ----------- ------ •-•---•-------------•---••......•-•----------- ......•-------•--------•---••-------•••---.........-------- -� , -t..�.-•�o - --.....------ --------------------------------- --• ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------•----------•-•--•------ ---------- -------------------------•----------------- ------------------------------------------------------------ FINAL INSPECTION BY:. .--- _ - --------- Date-----------------------/-�•--"-------��`----�------------- 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 ES-9 REVISED 0.59 F.P.CD.2M 6.60