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-;FOR OFFICE USE: -F . .. � --- -----_-----------------------"-_-- APPLICATION FOR SANITATION PERMIT Permit No. ....�_.r?_..G�__�/l -------------------------------------------------------- -, -------- --------- - .0 (Complete in Duplicate) Date Issued --- .2 _ ----------- _________ ___ This Permit Expires i 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 describ cal. r This application is made in compliance with County Ordinance No. 549. + 41 JOB ADDRESS D LOCATION_ ___ _. "_____________ _ ____________ Ilk Owner's Name--]-- --------------- ------ - --- -11,1-------------------.----- ----- --------------------------- Phone--------------- Address--------•-l---- ----------- ---- ----------------------------------------------------------------------..------•--------------......--------- Contractor's Name--------s- -----� (-------- �.Q.1 -------•--•------------------------•-•----•-------- Phone--••----•------•------------------- Installation will serve: Resident Apartment blouse ❑ Co mercial ❑ Trailer Court ❑ Motel Other ❑ f Number.of.living.units::.5--_Number of bedrooms iP__. Number of bathst.S�__ Lot size ____ ------ Water Supply: Public system [I Community system ❑ Private; .Depth to Water Tableq_17`rft Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________} No New Construction: Ye r�' ,E] FHA/VA., Yes❑ No TYPE OF. INSTALLATION AND SPECIFICATIONS: ' i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank,:,S Distance from nearest well__ APLI''Distance from foundation.-- -.Material _______________________________ .No. .of compartments---------------- e -;.-_-----F��.�,�aa�Liquid depth-----------------------•-Capacity--------------------... isposal Field: Disfance from nearest welL.�D-O_+Distance from foundation...__6t�__�..Distance to nearest lot li ef�..� ` ❑ Number of lines____ __ _ Length of each line__1 _� _�Q----.Width of trench------r _�__________________ i Type of filter materiaL__,�__._._ Depth of filter material___ ___ ______Total length----- �2.1_4�_________________ _ Seepage Pit: Distance to nearest well------ ____________Distance from foundation--------------------Distance to nearest lot line__.__________... ' ❑ Number of pits-------------__--_r-_'Lining material-----------------------Size: Diameter------------------------Depth--.-----------------..__-------_- Cesspool: Distance from nearest well-_-_____________Distance from foundation _.__,-_____.__-.Linin material____.._._____-._._---________________- - 9 Size: Diameter_______--_{_________ Li Liquid Ca Capacity ' ❑ Depth-------------------•-•--------------- ------------------------- - .Priv Distance from nearest well: � .- - ,_ .. . . .r- y; --------..._Distance from nearest building------------------------------------ ---- ❑ - k ... w. ----------------------------. -------- - ---- -- Distance to nearest lot line.--------- •- --=----------------------------- ------------------------ ---•--------------------- 'kr Remodeling an /or repairing { escribe : "�4 -__AQI_ -- ---- ------••-. ------ _ - ,�- d --------------------- ---•----------------•-•-•----------------------•-•-•----------------••-----•----------------------..---•--------------•--------------------- 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 regulations of the San Joaquin Local Health District. t (Signed) — = === - - --- ------------------------------------------- .-' "- _-_Owner and or-Contractor) t t`By------------------•------------------------------------------------------------------------- -----------=------------------------•-(Title) ------ -------- ------------ ------ ------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). E i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------"------ --.- - ---------------- DATE------ -----------------------------------------------I REVIEWED BY-------------------------------------------------------------------- DATE ._, ._.. ; - BUILDINGPERMIT ISSUED------------------ ----- ---------------- -------------------.._- DATE.------- ---------------------- °--- -f Alterations and/or recommendations_______------------.__-__._ - ---------------------------------------------------•-•-------•-------------•"-"---------------------- -•-------=---------•--------------••------------•------•---•-------------------------------------------------------••-- ---------------- ------------------- ------ ------------------------------------------------------••----------------.....--•---------------•----•--•----•------•--------------•-•-------------------•-- i -------------•---• ------------------------ -------------------'-----------------• ----------------------------------------- ----------------- FINAL INSPECTION BY:-------- ----------•---------------- Date---- ---—---6_�------------------------------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 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 REVISED 8-59 F.P.Ctl,2.6-60 li