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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT �' C Permit No. .: P�_�o/�r 7 --------,- ---------- Date Issued -------------- -- - (Complete in Duplicate) .. ............. 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 LOCATION. ________ -_� .:----- '� Owner's Name-------- ------ Phone................................... Address------------- -•--------------•-----------•-•-------------------------------------------------------_-__------•-----_--___--••••--------•---- Phone----------------------------------- Contractor's Name------------- �------- -- -------��-------------------_---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑�Motel ❑ Other ❑ Number of living units: .../.. Number of bedrooms J. Number of baths�_Z._ Lot size IE ldWL-ef_""------------ Water Supply: Public system ❑- Community system Private ❑ Depth to Water Table W. . ft. Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam [-] Clay Loam E3 Clay E] (- Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [Bo '"New Construction: Yes 9--No ❑ FHA/VA: Yes g� - 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 fsom fogndation-----IX-------.Material_.., p / No. of compartments_-_�-_._.____-...._Size�__X �6�-,A!s(.PLiquid depth__._.I�:-,.._ Capacity./7.0 o_.-__. Disposal Field: Distance from nearest welL_.�--------Distance from foundation.../_,d_�__._.Distance to nearestlof line_�1+�_____ Number of lines_._-____1;.�--._�------------- -Length of each line_____ r.�"_ -..+._...Width of trench.._Z--_........._............... Type of filter mate ria l_.�,>r-_4_ /4 Depth of filter material_-_ -----Total length....14::W............. •---------- Seepage Pit: Distance to nearest well-------- -----.-Distance from fo ndation____.1 .__.Distance to nearest lot line__+�__.._ ... �_� _____....Number of pits.......�...........Lining material.- Diameter-•.. --...-_.Depth. � _ Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material------------------------------------- n Size: Diameter--------------------------------------Depth_-------------------------------------------------Liquid Capacity---------------_----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------_-------_------------- F1 ________---_-__--_.-.❑ Distance to nearest lot line----------------------------------------------------------------- --- ------•-------•--•--------------------------M---* - ---•---------------- t � Remodeling and/or repairing (describe):----- s..=` ---•------......................................... --------------------------------------------------------------------------............................---------------------------------------------------------•-------------- -- I hereby certify that I have prepared this application and that the 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)-------- ^� '�="` -- ---------- ------------- ------------ ------_------------------------ (�1�°r Contractor) By:............. -------------------------------------- --- --- (Title) {�� (Plot plan, showing size of lot, location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_.. ._....�.- _f _. -r.�- '? - --------- DATE J ...............--------------- REVIEWEDBY-------------------------------------------- - ------------------------- -----------------------•-••---•--- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------_------------------- Alterationsand/or recommendations:_---------- --------------------------------------------------------------------------------------------------------------------------------------------- _._ ---._.•. -- 44, FINAL INSPECTION BY:----& .c..'...--!------- Date �-^�T-�c ----.... --------------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wort 9th S F Stockton,California Lodi,California Manteca,California Tracy,Cali Ee•9 R6V1■CD 9-3e F.P.0 D.7M 6.60