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- � FOR OFFICE USE: --- -------------------- - ---------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .1 .�... J�-- [Complete in Duplicate) -- - - -- -- .Date Issued 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. ti l f / -------------- JOB ADDRESS AND LOCATION - '�r---/ ---fes'-�I� - - - -A------ ------°^--•--------•-----------------------------------------------.......... Owner's .Name--- /,/!. ----------------- -------------------------------------------•=------------ = Phone one ¢a nJ Address........�' � -- --- ------ ----------- ------------------ - ------ Contractor's Name-------------------- ---------_--------s Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ Number of;living units: .___ Number of bedroomsJ_._.Number of baths 44-Lot size ,� �'rj"' ----- - ---------------------- Water Supply: Public system ❑' Community system ❑ Private [�Qepth to Water Tablec.. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date__."---_`-,__.._..) No ❑ New Construction: Yes (] No ❑ FHA/VA: Yes.❑ No ❑ TYPE-OF INSTALLATION AICD SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within.200 feet.) ,. k p' p stance from foundation______--------------Material______-•__----------_--------------_-----------. ni: D tit�a1 741 No. of com artments- well----------------Size----------r--------------------Liquid dePlh--------------------------Capacity----------------------- Disposal Field: Distance from nearest-well:'A .____Distance from foundation__ _ -----------Distance to nearest lot line_�r__.._._ /. Number of lines-------f'_--_--- __-- _Length of each line_��_-- Width of trench_- --.------;'--------------�--- of filter material_ �fDepth of filter material___ --------.____Total length'___.f �------ Type _ ` -- i T � 1 I'� o Seepage Pit: Distance to nearest well____1,A�_______Distance fr m''-foundation.____-____.._..D��ce to nearest lot li`.� Number of pits____/______________Lining material-_f.� / i_._Size: l]iameter__y __._ .____.--_Depth___=___-__._____ ____. Cesspool: Distance from nearest well.-----------------Distance from foundation---- ----------------Lining material_: __________---_____.__.________ ❑ Size: Diameter------ .:_ - -----------Depth----•----------- ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearost well--------------------- ._;---------------` distance from nearest building..,_--------=--:-!----_-------•---------- . . ❑ Distance to nearest lot line----------------------------- --------'--------•--------------------------------------- -- --------------------------- Remodeling and/or repairing Ide'scribel:_ - -----------------------------•-------- - ---- ----------------- -- = ------------------------•------------ ----------------------------------- I =------------------ -------------- --------------------------------------.---------°---------------------------------------••-=---==------------- ------------ - - ----- -- -- - - - - 'I hereby certify that I have prepared this application and that the work will 6e done in'accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -{�Avor Contractor) (Signed) --------- - ; --- _._-- --- -- = (Title)__. I Br• -...._.. I (Piot plan, showing size of lot, location ys+em in relation to wells, buildings, a+c.,'can be placed on reverse side). r " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ------------------------------------------ DATE• / Ig-^ . . t ------ REVIEWEDBY------- ----------------- :.---------- -------- ------•- ----- ------ ------------- DATE----------------------------------- ---------- ------ I ------ DATE-------------------- ----- - -BUILDING PERMIT ISSUED---=-•------------------------ ----------------------------•------•....._ _ -- --- ------- Altera+ions and/or recommendationsz____=art-=-- ------ - ' " i -------•---------- ------------- - ----- ------ --- ------ -- ------ - --- •------------- Date Date-- -----------------..._. ------ --- - -- - FINAL INSPECTI :- -.. �! %�'l .S F� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street .F .124 Sycamore Street i 205 Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 0.59 r-P.DD.7M 6.60