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-- ��-r�� FFAE U E: = =x j:�� 1 --------------------------------------------- Gf_ ' APPLICATION FOR SANITATION PERMIT Permit NO. ----------------------�i -- ------------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued 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.._...._.._._.__ — _X_r ---.-•-•••••--• ..... '�...... ............••------••-•--••---•----......•-•--- Owner's Name__________________••-_•- . £� •• . ............ ------------------------ Phone---------...---•-•--------••-------- Address--•---••-----------••-••-- 6 a.- ------•--•-•--••-----_� ---------------•-•--------------------•----------...._....--•-•----•- Contractor's Name...................... ------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living _ ._ units: � Number of bedrooms .--A-. Number of baths,,L_... Lot size ............ _...._.__. �',�.•_•-__3•S"G�_ ��, Water Supply: Public system ®' Community system ❑ Private ❑ Depth to Water Table -------- ft. ; , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [1"Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No4a New Construction: Yes Er No ❑ FHA/VA: Yes ❑ 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.from foundation-___-./!!:_.-___.Material_____________ No. of compartments_.____ ----• .......... --______________Size_.+.)L.�'-�-�--_,'_Liquid depth---------- rr o -----Capacity..--- ...... Disposal Field: Distance from nearest well----- oo'-Distance from foundation.__.... a!.....Distance to neatest lot line.....�E-... Number of lines--------- _-__ __ Length of each line_-6:d__ —f- . /idth of trench............2A." Type of filter material..._-- _ _ -__Depth of filter material-----/�t ........ length........../_6._.0_................. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.......................Depth................................. Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material..................................... Q ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity . gals. Privy: Distance from nearest well____________________________--------- -Distance from nearest building ❑ Distance to nearest lot line_________________________________________________�_ Remodeling and/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 rules and reg lations of the San Joaquin Local Health District. (Signed)....................... i 't - (Owner end/or Contractor) By:. ----- ---------------------------------------(rifle)---••---•--•- Plot plan, showing siz f lot, location system in re ion to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....�.,�, C.0j ..........................................---- DATE -............................. REVIEWED BY--------------------------------------- �- --- ----�'- ------------------------------------------------------------------------------------- DATE.._.. . BUILDING PERMIT ISSUED---------•-----•---------------- - -................-.............................. ---- • . ------- - DATE---------- ---------- --- ---- - Alterations and/or recommendations:----___ ______ -- --------- -------•------- --- ----------------------------------- --- FINAL INSPECTION --- - Date---------- �� SAN JOAQUIN LOCAL HEALTH DISTRICT X 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 nEV18 ED 8-89 ZM 5-61 ATLAS