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t -UK UI -Flet USE: ----------------- --- "---------------------------------- ----------------- ---- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... ........ ..... .l..0 -------------------------------------------------------- (Complete in Duplicate) %� / ------------- 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND'LOCATION---- `j __-----f �6',e •---------------------------------------------- --•--------•-•----------------------------------------- � F Owner's Name ---- C/y,,._._,�-_- _ !� li�----------•------------------------------------------------------------------- Phone Address ---- - ..:. Contractor's Name----------------------------------•---...................... ------------------ Phone ----------------------------------- Installation will serve: Residence Eg/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms_ Number of baths ___I__ Lot' size _ Water Supply: Public system ZK-c"ommunity system ❑ Private ❑ Depth to Water Table .1-41-w Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3,--Mardpan ❑ Previous Application Made: (If yes,date--------------- -----) No New Construction: Yes ❑ No 2-FHA/VA: Yes ❑ No 9�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SP tic TaKk:/- Distance from nearest well_________________ Distance from foundation -------------------- Material ___.__________.______.._________--------.._____- No. of compartments ----------------------- --- Size ---------------------- : -----•--- Liquid depth --------- - ---------------.Capacity----------------------- Disposal 561d: Distance from nearest well_________________ Distance from foundation -------------------- Distance to nearest lot line ______-__-__.___ Number of lines----------------------------------- Length of each line ------------------------------Width of french --------------------------------- Type of filter material_________________________ Depth of filter material ----------------------- Total length _--......________:__.--------------------- I Seepage Pit: Distance to nearest well_.___'..____- __Distance from foundation__Z[.!__ �___.D'stance to nearest lot line_1_._ ��} ___ M/ Number of p'its__._Z-------------- Lining material__- A _.Size: Diameterq,---------- Depth__ -Z e.�____?-------------- (^ Cesspool: Distance from nearest well ----------------- Distance from foundation -------------- ._._:.Lining material -------------------------------------- 11 Size: Diameter -------------------------------------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building _______._____.________________-_-_____.._. ❑ Distance to nearest lot line ------------------------ --- --------------------••--------------------------------------------------------------- v 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)------------------- ----------------------------------'�or Contractor) By----------------- ------------(Title)---- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENLUSE ONLY ------ --DATE BY --- • -----• -- - -- ---------------- --- - - --- ---�� - - --_--_------=------------• - -`---- �------------------- APPLICATION ACCEPTED- ------------------------------------------•--•--------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------•----------—-------------------------------------- DATE. -------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------------•----- --------•---------------------------------- - - ------------ _. .. - % �. --- ----------- ---- ---- ------ ---- --- C'2�....:...F �x1' ------------------•-- FINAL INSPECTION BY:._.._`- ____�_Z[%7"-�"'/ pate.... -.z___6 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E6-9 R9V19E0 a-59 F•.P.00. 2M 6.60 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi, California ' Manteca, California Tracy, California