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FO OFFICE. SE APPLICATION FOR SANITATION PERMIT Permit No. .... _.._. ------------------------------------------------ ------- (Complete in Duplicate) Date Issued -- ------------------- ------------- 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. JOB ADDRESS A D LOCATION .'--- = ' ----------------------------- Owner's Name = = - l�/-. •--------------------------••----------------------------- --------I--•--------------- Phone rye, Q ---•----------•-•---••......................•--------••------•--------• --------------•------- •--- r Address.-••-•------------------- .. .. ._..- p� .�►-- Contractor's Name-------------------� _-`�--- 1/C; c __-S'e _ /c` ....------------------.------------ Phone-I] - 6 `7 7 Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court j] Motel ❑ Other ❑ Number of living units: Number of bedrooms -_ _ Number of baths __Z..__ Lot size - - oZ ---------------------------------- Water Supply: Public system [Ir 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 a New Construction:11 Yes [9— No ❑ FHA/VA. Yes ❑ No PD�,_ v' 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- AAr& ___Distance from foundation---10...........Material----- __ �� [ No. of compartments_______-2 ______________Size....., - c5 --------Liquid depth----- __'-------------- Capacity---- Disposal Field: Distance from nearest weil_✓ .._.Distance from foundation---1A...........Distance to nearest lot line__`___-_____- DNumber of lines______________/---- - Length of each line_______7t_--__________._.Width of trench------.�__9_f._________----------------- Type of filter material_ _ --- -_-__Depth of filter material----/i�__`-_______._Total length------�a_'__________________________ Seepage Pit: Distance to nearest well_.,xrv-x-C--------Distance from foundation---A?............Distance to nearest lot iine._�E-_____.._ Fil, Number of pits_ ._Y_____________.Lining material_______7T�x0_f----Size: Diameter_.___ _ Depth_________ rs_______________ Cesspool: -Distance from nearest well-----------------Distance from foundation--------------------Lining material.------------------------------------- ` ❑ Size: Diameter---- ---------------------------------De th---------------------•------------------ ----Li Liquid Capacity gals. Depth q P tY f Privy:_ Distance from nearest wefl----- ------------------------------ -- ---._._Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line-------- ---------------------------------------•-----------•-----••------------------------------------ ------------ ---------------- Remodel' g a , or repa' ing describe:_ 1CC c z �Dl" "`�: ` r--------•--- i Com' -- - - ----- -- ---------� - - --- ---= .. --••-----•---•------------------•---•---------------•-•----------------------------- Thereby certify that I have prepared this a plication and that fhe`work will be done in accordance with San Joaquin County ordinances, State laws,`and rules and regulatio of the San Joaquin Local Health District. ---- ------ ---- --- --- -------- ------------------------------------------------------------------------------------Owner and/or Contractor (Signed)-------------•--- ---------- / ) By---------------------- --------------------------- ------------------------------------------------------------------------------(Title)----------------------------------------- ...------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •-' �7 = --------------•--••----- ---- DATE----- -� �a/--- / --------------------- REVIEWEDBY----------------------------------------------- -------------------------------------------------------------------------------- DATE- --------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------___---------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------- - -- ------------•---------------...-•-------•==•=•-=----....-------------------------....-------------•-------------- -------------•-----------•---------�---..---- =-- -- -----n-------- -------------n------- -- -/0 / //I�! ( ------------------------------------------------------ r -------------------- ---•-------- t �- -. - - = -------------------- ---- ----------------------------------------------------------------------------------- ----- --- Date------ �> :.._ _.- ----------------------- FINAL INSPECTION BY:_EYC_-- '�'4-�� ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street l r . Stockton,California Lodi,California Manteca,California 'Tracy,'California I EB,t REVISED 9.69 r.P.CC.7M 6.60 F 'A