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FO FFICE USE: __________________________________ _____________________ APPLICATION FOR SANITATION PERMIT Permit No. ...4�............ -- ------- (Complete in Duplicate) 7 / ----------------------- ________ _________ __.___ This Permit Expires 1 Year From Date Issued Date Issued ._..._l�G 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 OCATION..... ✓�'tt�'_.._,S�ti...... L _ , / '/?? Owner's Name------- -------- ------ Phone.................................... Address = �� iit,zLC? ---------------•-----------••-----•-------------------------•-•-------------.-.----------------------...... Contractor's Name------- ----••-• � f .N^ t� '� Phone Installation will serve: Residence ❑ Apartment House commercial ❑ Trailer Court ❑ Motel ❑ Other / Number of living units: __ - Number of bedrooms ---�J. Number of baths __A-.. Lot size ........K 7 ;�"?-' ............... Water Supply: Public system ❑ Community system ❑ Private [19-�epth to Water Table ....._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) Septic Ta Distance from nearest well_..b. �___..Distance from foundation__.__ ._____..Materi�J_..___ C�`___ ____________ No. of compartments----------- ..____Size...:------------------------....Liquid depth......,1.._.-_____-_Capacity...... �8�� Disposal Field: Distance from nearest well----�SV_.._Distance from foundation....,1Q._.......Distance to nearest lot line------�__..... Number of lines....... _____ _ Length of each line_._.__��`_�`.7�Width of trench-_____-7K.:__ .............. Type of filter material_.__ Depth of filter 'material..._._4------------Total length-------/_!9:........................ Seepage Pit: Distance to nearest wail________________A_._Distance from foundation....................Distance to nearest lot line-----------_---- El Number of pits---------..........._, finingaterial______•.----------.---.Size: Diameter.........._------------Depth--------------------------------- Cesspool: Distance from nearest well_________________ istaiice from foundation____________...____.Lining material...................................... ❑ Size: Diameter-------------------------------------- epth----------------------------------------------------Liquid Capacity----_-----_----------•----gals. 5 Privy: Distance from nearest well-______________ ------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line r•--------••-•-----------•---------------------------------------------•----------------------------------•------------------ Remodeling d/or repairing (describe :__--- „a�oy --- - -- t __..-_� s 4, --- ------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------- ...................-•---•-•--------------------------------------...................................---------- I hereby certify that I have prepared Ws',aopl c�#on enc( that the work will be done in accordance with San Joaquin County ordinances, S)ato laws, and rules and regulations of the S ,ap>'aquin Local Health District. (Signed) --- -- -- --' ------------------------- ----- --------- ------------------ '--------------------- ---•- ------------------------------------------(Owner and/or Contractor) BY•-�--------------------- -------------------------------`��---------------- (Title) ----------------- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENY USE ONLY APPLICATION ACCEPTED ---------------------------------------------------------------- DATE---------- --Ga -------------------- REVIEWEDBY-----------------------------•-------- --------------------------- •-------•-••-----..._... DATE................................................----------- BUILDINGPERMIT ISSUED.............................................................._...................................... DATE-------------------------------------------------------•---•- Alterations and/or recommendations:----_--------_-------- ------------------------------------------------.................................-----------------•----------=-------------------- -----------------------------------------------•••--------------------------•----------------------. _.----- ----..................................................................................................... -------------------------------------------------------------------------------------_------------------------------------------------------------------------------------------------------•---------------------------•-•. ------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------••-•-------------------••--•------•--------- --------------------------------------------------------------------------------- --------------------------------------------......._....----.....------------------------------------------------------------••---•--- FINAL INSPECTION BY: ---------.--�----------------------------------- Date----------- --------------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Watt 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REVISED 8.69 F.P.CD.2M 6.60