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FOR OFF CE, USE: ' 3t --- - ---- - -- __ t4;, APPLICATION FOR SANITATION PERMIT Permit No. .............. ----------------------------------------------------- --- (Complete in Duplicate) ------------------------------------------------ y This Permit Expires 1 Year From Date Issued Date Issued ...../........ � Application is hereby made to the San Joaquin Local Health District for a permit to construct d i all the work herein described. This application is made in compliance with Count Ordinance No. 549. ,1• �� JOB ADDRESS AND L C ON n ----- Owner's Name P�one----------------------------- ` ----------- = Address------ ! B, '� 1L/U� ----------------------=--------------------•--------•------ Contractor's Name — - Phone =-------------------_-- .. ----------------------------------- Installation will serve: Residence 5'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�__ Number of bedrooms_- Number ' of baths/ Lot size_s00le/1- r--------_------_......._-------- jr F Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Af ft. 11 Character of soil to a depth of 3 feet: Sand ❑ Gravel-D Sandy Loam ❑ Clay Loam�L&-Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date-------------------j` No ❑ New Construction: Yes E] 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 T nk: Distance from nearest well- __-. .pistanc�f from foundation__ _ r� No. of compartments____ ___.______-f_Size_��_rX__ _.___Liquid d�th___- _______________Capacity___ __� ___ u l Disposal Field: Qistarice from nearest well. --P`---Distgance from foundatio�_`�_--------Distance to nearest lotline_ Y__.__. s'' - -------------- ^ � } Number of lines-'----/-/_______ _ Len th of each line____! Width of trench._" ._.___ W Type of filter rAaferial_ Ar4_6/ _Depth of filter material_____ ------------Total length-__,1�*4_f�------------------------ Seepage Pit: DistanceJo nearest well__'/00___----Distance fr2m fc dation_---f� .___FD t to nearest lot line_________-_ Number of pits------ __ �_____Lining material. _ - G -size: Diame+er_. Depth_ _ts ________________ Cesspool: Distance from nearest well----------------_Distance from foundation--------------_:_...Lining material__._____-___________.______.___-____ ❑ Size: Diameter-------- ----------.--=-- --------Depth---------------------------•----------------- Liquid Capacity----------------------------gals, Priv Distance from nearest well_____________________ ____-_Distance fro' .nearest building------------------------------------------ ❑ Distance to nearest lot line-----••-- ------------------- ------ ------------- ------------ 1 -------- Remodeling and/or repairing (describe)-------------' �------- .�. � dry - -- -------------- ----------------------------------------------------------•-•--------------------------------•-.-•---•------------------•--------------------------------------•---•---------------.----•------------------------------"-... I I hereby certify that 1 have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws, of�jioca�fl&nof regulations of he San Joaquin Local Health District. (Signed)--------------------------- -- ----------------------------------------------------------•------------------------(� Contractor) By:--------------------------- -----------------------------------------------------------(Title)----- / � ..---- ----- (Plot plan, showing size system in relation to wells, buildings, etc., can be placed on reverse side). LFOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY-------- ` ��= ��- ----------------------------------------------------------- DATE----------- T -------------- -- REVIEWEDBY--------------------------- -------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED---•-------------- -------------------------------------------—--------••---------------------- DATE-------------..---------------------------------------------- Alterations and/or recommendations----------------------------------------------- ---------------------------------------------=----------------•----------------------•-•----------------------- - -- -- r__.... . -- --------------------•---------•------•--••---•------------------•----------------------------------- FINAL INSPECTION BY: ' ------------ Date------- �� ------------------------------------- SAN.JOAQUIN LOCAL.HEALTH DISTRICT r 130 South American$treat 300 WestOak$treat. y -,,1'24 Sycamor Strest 'R 205 West 9th Street Stockton,California Lodi,California Manteca,California �� Tracy`California ES-9 REVISED e-59 F,F.CD.7M 6.4D ��i