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FOR OFFICE USE: t� - APPLICATION FOR SANITATION PI=RMIT Permit�Nv. _._._9. !�__.-_----_- ---------------------=q------ -------------------------- (Complete in Duplicate) .ate / This Permit Expires 1 Year From.Date Issued ba+e sued _._..___._., !__�/ 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 rdinance No. 549. JOB ADDRESS AND L CAT O � -- -------- I�-------•--------------------- - Owner's Name------- % --�-- •--------- ---- - ----- -------------..---------------------------------------- Phone..........-_-------••-_----•-•--- Address__. - --- - I Contractor's NameLZ - ------ --------------------•------------------------- -----------------•-•------ Phone................................... Installation will serve: Residence (�] Ararfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1__- Number of bedrooms __ _ Number of baths --_i-_ Lot size ._�f __. .....��---------------------- Water Supply: ,Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V]--Rardpan ❑ Previous Application Made: {If yes,date____________________I No. New Construction: Yes g3-"N-o ❑ FHA/VA: Yes ❑ No I4-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) / Septic T nk: Distance from nearest well-JyQri ---.-.Distance from foundation--Za__�--____.Material-------------------------------------------------- E�r . No. of compartments------_;2--------------Size...... _ st-_ -----Liquid clepth.....�--------------Capacity d .__ Disposal i d: Distance from nearest well.:�V----_Distance from foundation_ d +...Distance to nearest lot line----Z,--- Number of lines---------------- ----------------Length of each line-------_l/__6_"._....._._..._.Width of trench----------.r�__f'__g-__------_-- Type of filter material------i"F-'<----_--_Depth of filter material----L�'_----------Total length--------------�D--_---__----------- Seepage Pit; Distance to nearest well ._.___Distance from foundation____.__... Distance to nearest lot line__________ ❑_� Number of pits__'.'J-------------Lining material__ .e__�--..Size: Diameter--_ ___Depth_.___.___=2's`'-_____-- e, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter---------=------------------- __:1--- Depth---------------------------------------------------Liquid Capacity----------------------------gals. I ' Privy: Distance Distance to from nearest well-------------------------------:------------------Distance from nearest building------------------------------------------ est lot line Remodeling and/or repairing (describe):--------------------------------- --------•---•--------------------------------------•--•-----.------.---•-------•-------.----- ------------------- k ------------------------------------------_----__-----__----___---_--_-_-_---_______----___------_-- _____---___--_-_------______----_____-------_--------__-_-_-_---_____-----__----•__------_._--___--_-._..-____-__.____ I hereby certify that I have pre 1 d this application and that +he work will be_done in accordance with San Joaquin Coun+y ordinances, State laws, and rules a reg tions of the San Joaquin Local Health Dis+rict. (Signed). ------------- ----- (Owner and/or Contractor) By:------------------------------------ - =- ---- -----------•-------.----(Title)---------- -------------------------------------------------- - -- --------------------------------------------- (Plot plan, showing size of lot, loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------- ----------- -------------------------------------------------- DATE------- ------ REVIEWED BY ----------- . -• ------- _.. DATE---.--- - -- ------ - BUILDING PERMIT �- �ISSUED--------------------------- -------t- -- -----------------------•------ -----------------•--------------- DATE---------------- ---------------------------------•---•--- Alterations and/or recommend t. - --- -=---.ns -------- - -------- � ..._ X...... ..L -A -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----•.--- ------------------------------------- -� ------------------------------------------------------------------- ---••------------------- ---._...--•- -•--•-----• ----......--------------•---------------------------- FINAL INSPECTION` BY: Y C 1 -rte'----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lotti,California Manteca,California Tracy,California 99-9 REy19ED 9-¢9 F.P.DO.SM 6.60