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I tJ � ✓ 79 APPLICATION FOR SANITATION PERMIT Permit No. ....�I -- � { omplete in Duplicate) HZ Date Issued ------�/-71ij 7i/ / Application is hereby made to the San Joa uin Healt District for a permit to construct and install the work herein described. This application is made in compliance with Ordinance No. 549. JOB ADDRESS 'AND ATI . ------ ---- --_ ------------------------------------------------------------------------- Owner's Name----------- ----- --- -- - - ---•• -- ---------- Phone------------------------ . :_ --- ---•- Address 1�--1�---f-- � - ...._.- Contractor's Name--- ---•---------- � -------------------------------------------------------------- Phone--------'------------------------ a Installation will serve:'*,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number'of living units: _ __ Number of bedrooms __ Number of baths/ _ Lot size _ x __________________________ ; Water Supply: Public system ❑ Community system Priva+e ❑ Depth to Water Table ft. Character of soil to a depth"of 3 fee+:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam :0 Clay ❑ Adobe Hardpan ❑ i Previous Application Made: Yes ❑ No �ew Construction: Yes 2 Ko ❑ FHA/VA: Yes ®�� TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i x Septic Tank Distance from nearest,well_ __ _Distance from foundation___ Mater �� i Liquid firtyNo. of tom artments_ __ 5ize_ // %hde _._ _.Ca -- -- Disposal F' Distance from nearest well�j ___._Distance from foundation__ Distance to nearest I t ine-- Number of lines____ Length of each line__ e �s Width of trench---"'// ------'// p ff g --------------- Type of filter material- i-4Depfh of fdfer material---��--!_-----Total length-----,l p Seepage •t: Distance to nearest well--- a?_-----------Distance from foundation--_,4.�"__e,..Disfan e to nearest lot lino-�. Number of pits------ r�_--------Lining material-_ ��1Size: Diameter____,____--__.--- Depth- f�_ ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining maferial-----_------------------ X El1_____________. Size: Diameter-------------- ----- ---- ------Depth---------- '-*-------------------------- --- - Liquid Capacity------------------ - � Privy: Distance from nearest well _______________________________________________-Distance frominearest building-----h_______._____-________----------_ ❑ Distance to nearest lot line ------------------------------ --------------------------- ---------- -----------,---- Remodeling and/or repairing (describe) = ---------------------_.---= ------------------------- -------------------•------------------------------------------------------------=----------------------------•---•------------------------------------------------ --------------------------- - ( --------------------------------------------------------------------=-----------------------------------------------------------------------------•-----------------------------------------------------------------•--------- I I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dis+ric+. Si ned ----------------- Contractor) By:------------------------------------ -- - - ± ---------------------------------------------(Title)-- �C `--!-- ---------- - (Plot plan, showing size of lot, loc n of sys+em in.rela+ion to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------------------•------------•--------------- DATE REVIEWED BY = - ------------------------------ DATE BUILDING PERMIT ISSUED----------------- - ----------- ------------- DATE----------- Alterations and/or recomm a+ions:-_______ -------- ------------------------------ __ ---------------- ------------- -------------••-•-------•------------------------------- - --- -- -- -- - (- - Del------------------ --------- --------S~G T Ir -----•------------- --------------•---------------------------------------------------------------------------)-------------------------------------------------------------------------------- i ------------------------------------------------------------------------ ------------------------------------------------------------ FINAL INSPECTION BY:--------------!!._. --------------------------------- Date------------- -- -� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stroet 814 North "C" Street Stockton, California l..odl, California Manteca, California Tracy, California ` a ES----9-•--2M Revises 3-57 F.P.00- ` e '