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FOR OFFICE ` J¢� O -' ICATION FOR SANITATION PERMIT Permit No. ... .. .1. .? ----------------------------------------- --------------- (Complete in Duplicate) Date Issued ---_.•_.l_._._r_ ._6 � -------------___________________-------------------------- 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. ryry ® ---•---•--•----------••------••-----...... JOB ADDRESS AND CATION. fl---. .=---•• r� 1/ -----��A_ --•-------------------------- Owner's Name-_-------- .�fi�1-1,��. �r ---------------------------------------------------------------------- Phone.................................... Address................... ......... - ----- Contractor's Name.................. t` -----...............................-........................................... Phone................................... Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f--- Number of bedrooms -_/-. Number of baths .4--- Lot size v0ZX1,Z-49----------------------------------- i 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 ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes [tom No ❑ FHA/VA: Yes ❑ No ❑--, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septie apk: Distance from nearest well_______________ Distance from foundation....................Material................................................. 4No. of compartments-----------------•-.---_Size................................Liquid dent--•-----------------------Capacity-------------------•- Disposal ield: Distance from nearer well....__- --------Distance from foundation../wE_......Distance to nearest lot line.........../.. Number of lines_______ ________ _______ _ ____ .. � ._ Length of each line;_____��.�� Width of trench._._._....................... Type of filter material2� �_ _._Depth of filter material_Ato' ------------Total length.....//P...... ................... \F -___-__Distance from foundation.._ // -_-Distance to nearest lot line_ V Seepage Pit: Distance to nearest well_____ .CtzB---- �•----- [� Number of pits-----I-------------Lining material. p-G1 ----- Size: Diameter-_,17"*-_---__:Depth__ ............------- Cesspool: Distance from nearest well..•______________Distance from foundation--------------------Lining material--__.-_--___-..---___-__---__-_------. ❑ Size: Diameter------------------------------------- Depth---------------------------------- -----------------Liquid Capacity............................gals. Privy: Distance from nearest well------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)---------------------- - -. -. --- - -----. ---------------------- •----------------------------------------------------�'�War Contractor) By:................................................................. ----- ----------------------- --(Title) �i----------------------------------- (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---'-- ------- --- - - - ---------------------------------------- DATE------- --_----------------------- REVIEWED BY -------------- - --------------------------------- DATE BUILDINGPERMIT ISSUED_-----------------------------------------•--------------•---------------------------------------- DATE............................................................. Alterationsand/or recommendations---------------------------------------------------------••••---•--------------•------•-••--•--•-••---...----•---•------•-----••--------••--...---...-•-- -------------------------------------------------------------------------------------------------_-----------------------•-------•-••-----•---•-------•••-----•-------------•-----------------••--------------------- -------------- ---- -------- - ------------------- ----••--••-• - - - ------- ----------------- _.__._.. _-_--___i__y.--__..-____-__-__.__-__-..-______._._-----.-_...___-..________-.___-_.__-__---.____-___-_.___---__-__---_.---.- (Y ................................ FINAL INSPE�T1 N B - - - ---- ------------ - Date...-----S....... 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 E®•9 REVISED S•S9 F.P.CD.SM 6.60