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FOR OFFICE li�___In_-5-_...____ -------------- APPLICATION FOR SANITATION PERMIT P ----------------- --------- No. ........................ -------------- ---------------------------------------- (Complete in Duplicate) Date Issued l6' ------------ ---- _____________________________________ 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. ,t c -�- / c._et JOB ADDRESS AND LOCATION- � -. //� Z_ �:� -=j' = - ------ �'-/----- . Owner's Name---------------�� t � r� ' '`-jlz: `` ------------------------------- Phone. . --•C=-= •------' ---- Address - f �`� .. �/ . ......fit.... -1 O ----------••... F Contractor's Name......... ' I^- .-• ------------------- ------------------------------------------------------ Phone................................... Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: ../__ Number of bedrooms ___` . Number of baths __ __ Lot size............. . ....... Water Supply: Public system E] Community system [IPrivate Depth to Water Table ..L-:�T. 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 (3 New Construction: Yes g No ❑ FHA/VA:Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well______S:cDistance from foundation.___(,�:'_..__.Material___t_' __. [� No. of compartments-------------- -------Size----_._ ,1_?,_,t�_.i Liquid depth...__..._ ..____..________Capacity........ Disposal Field: Distance from nearest ----Distance from foundation....... ..__Distance to nearest lot line....... -K 91 Number of lines_____________s- Length of each line---------1i_�'__....Width of trench-------------�----....__.._ � Type of filter material-- cr. c�...Depth of filter material_____/_: ------------Total length---------7__!." :_....�lRg Seepage Pit: Distance to nearest well__--------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------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------------------------------------------------------------------------------------------------------------------------ --------------------- Remodelingand/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 regulatiops of the San Joaquin Local Health District. (�\� (Signed) �� :Fi_L '1'. ___.-5. _'_L_� =� _-.- _-.---- --__(Owner and/or Contracto By:----------------------------------r ------ --------------=-�-------------- --------------------------------------------(rtle)...... ------------------------------------- _----_-----------_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). '; OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- --- ..................................................... DATE------... ------------ REVIEWEDBY---------------------------------------- •------- DATE------------------------------------•----------•-----•-•--- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------•--- DATE--------------------------------------------- ............... Alterations and/or recommendations---------------------------------------------------------------------------------------------- ------ ••----•---- -------------------------------------------------------- --------------------------------------------------------------------------- �' . -- ---------------------------•--------...---------•------------------------------------•---------------------------•---•-•- ----------------------•--f----6--- -- 'Q.....----------•..... --f-- --- ---------------•-------- -- FINAL INSPECTION BY:------ ` c-- ------------ ----------- --------- Date. ��'�/.. 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 Ee•9 REVIs EO a-so F.P.CC.7M 6.60