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FOR OFF[ SE: / - Z. `� -- APPLICATION FOR SANITATION _ rmit No. . 1 � �t + � - ------------- R (Complete in Duplicate) ----------------------------__ �__. _____._.____.___ This Permit Expires 1 Year From Date Issued Date Issued '.?................ 1 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. 49. .. JOB ADDRESS AND LOCATION. D __._ :".i. ................... Owner's Name--• ✓' !'- �/:Zt1:[ za:�,ac!/_ --------------------- J -------------- Phone.................................... Address................................................. -: - �••- •-••-•.........••--• ••--•----•-----••-•-•---.......--••••---- . t Contractors Name••--- �' ,_ '� F _ l ................ Phone................................... Installation will serve: Residence [ia Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..I----- Number of bedrooms -2___ Number of baths )/2. Lot size ..... --------------------- Water Supply: Public system ❑ Community system ❑ Private [k Depth to Water Table A' _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ey Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Ef New Construction: Yes lr No ❑ FHA/VA: Yes ❑ No Q 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__�_=v_______.Distance from foundation-6e..............Material__��%'_ ��-__----- 0'% ----- •. D'" No. of compartments_____.1---------------Size..... --------Liquid depth_-°-'-h.................Capacity. -/.0.1'_,_j..-x_/ Disposal Field: Distance from nearest well-Se..........Distance from foundation..L..............Distance to nearest lot rine...s-ti......... U ❑' 'Number of lines__________________-_--------------Length of each line--------7 -------------Width of trench........A."-."__-----_----_---_ Type of filter material.-:.1(en(A-_____-__-Depth of filter material-----R..............Total length............ ................. Q Seepage Pit: Distance to nearest well--10,,1_____________Distance from foundation--7,6---------------Distance to nearest lot line�`_�_.._..._.. rrQ�� IT Number of pits___'1-----------Lining material____�!_Gk--------Size: Diameter-_- 3--------------Depth-----..__ v_'..............• (4 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-----------------------------------------------------------------------------•---•--......--•-----•--•--•------------..•..........----------- Remodelingand/or repairing (describe) -----------------------------------------------------------------------------•------------•---.................................................. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------••------------------ -------------- 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,.rt ' and r ulations of the San Joaquin Local Health District. .. (Signed) !/---------- ----------------------------------------------------------------------------------------------- (Owner and/or Contractor) By:................i-...... . ... (rile)--- ----- --- (Plot plan, showing siz to#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------- -•----•------•----------•---•- DATE----- z" ---------------- REVIEWEDBY............-----------•--------------------------------------------------•-----------•-----•-------•-•------•••---•••..... DATE................._......................................... BUILDINGPERMIT ISSUED.............................................................. •--------•------- DATE............................................................. Alterationsand/or recommendations:--------------------------------------------------------••------------•--••----•---•-••------••••---•-•----•••--•-•••-------••---------------.....--•------•- -----------------1-------- ------------------ '- = 1-'-------6 ------� -:��-----z�'``.. � �� ....._��... -------------------------------------------------------•-------------=---=------ ----------------- ..-----...----------------------------------------•--------------•------------------••------•-••--••......---- --------------------------------------------------------------------------------- -------------------- ---••-•-• E ---•-•----------•------------------------------•----------------•---••--•---•---- FINAL INSPECTION BY:.._ __.. . _�____ '__.___ _ _ _� <.-�'-ti�• Date.....:.......v__>......... /=--•- -----------------------------•- 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 96.9 REVIBEO 8.69 F.P.00,7M 6.60