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to - 11 APPLICATION FOR SANITATION PERMIT Permit No. .__ ' (Complete in Duplicate) $� Date Issued'(�jA ---------- -- "� 3 plication is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance . 549. • rw JOBADDRESS AND`L TIO /` . ......-- ----------------------•------------------------------------------ `� ------ Owner s Name-------------------- L------:- � -- -- -------- �`-------`•------------- ----- ----------•--------------------------- -------------------- Phone ----------- I Address1y --•------------------------------------------------------•-----•-••----------------------------- Contractor's Name___________ __ -- ---- -_------- A '� - Phone Installation will serve: Residence Apartment House L]. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingiunits: ,--/ 'Number of bedrooms Number of baths __/___ Lot size _ -X 4,4---________ Water Supply- Public system Community system ❑ Private [j Depth to Water Table -------- ft. Character of soil to a depth of 3 feet i Sand E] Gravel ❑ 5andy LoClay Loam ❑ Clay E] Adobe Hardpan E]Previous Application Made: Yeso E] New�Construction: am Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:,, (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) y is T k: Distance from nearest well________________Distance 'from foundation-------------------.Material-----------------------------.___---------------- i No. of cbmpartm'ents `.. Size= - quid depth - Capacity __ Dis osal Fel �/ Distance from-nearest well. .._ �_istance from foundat n__ ___.Distance to nearest lot f } Number of lines-______1 ---Length th of each line_ f �4 ---- Width of trench.__--� ___ i Type of filter materia _rr_ -- ___Depth of filter material____._ __-__-__.Total lengfh______Z �______________________ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line------ ..-____._ N ❑ Number opits material-----------------------Size: Diameter--------------------------Depth--------------------------------- 1 u f its 3 Cesspool: Distance •from nearest well-----------------Distance from foundation--------------------Liriing materiai-----_______---------__-..__-.--_____. A ❑ . D ------------------------------- -. Liquid Capacity------------------ gals. = Privy: Distance from nearest-well---------_-----___________-___--_-_.- --Distance from nearest building-.--.--__-.-______________________--_._._. ❑ Distance to nearest lot line----------------------------"------------------•-------------------•--------------- ------------------------------------------------------ l - i i. Remodeling and/o r, scram}=:---------- ' — ! ------------- -- -- G - ,Z --- -,--- - , -; -:-------- - ----------+--,----------------------------------•---------------------------------------------------------------------------- - - ------------ ------------- -------------------------------------------------------- , ------- ! hereby certify that I have prepare this application and that •-• ------------------------------ k hat the work will be done in accordance with San Joaquin County ordinances. Sta laws, and les and regulations of the San Joaquin Local Health District. 1 f i (Signed) ?e_ _ t-- -/� -- {Owner d/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). y FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED'BY------ == -- - -------------- ------------------•------I---------------- DATE } - -------- ----------------- REVIEWED BY -- ------- DATE BUILDINGPERMIT ISSUED------------------------------ -- --- ---- -:----------—------------------- DATE - -- --------------------------------------- Alterations and/or recommendations:-------.------__. ___ --------------------------------------- �7-i14�------(-�------- 0T .----� ' RSA `Tt ----------------=------------- �_�I = = �-k Iw�r� � ' 1 - ------•------------------------ ------------------ ------------------------------------------------------ FINAL INSPECTIO - - - -- - - - -- - -- ----- --------- - --- Date----- ------ ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revisaa 1-57 F.P.CO.