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FOR'OFFI E gSE:I Permit No. APPLICATION FOR SANITATION PERMIT ,.�. --- ---------------- ------------- --- - ----------------------------- -------------------- -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ---r�/17_/0- 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 AN.D LOCATION..._.�e. � � V� f_ C~.r--� -:. ..- -----------------•--•---•-------------------- t lrOwner's Name . h.1 Phone >/ Address_-. -- -- ---------. -••-- Contractor's Name. CLC4 k.�:_-_- � .. •`-.. Phone__*d' r!._. -. 1. � Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: --I---- Number of bedrooms _ _ Number of baths --/_ Lot size .,�_' -- 11 ------------------- Water Supply: Public-system,Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Aclobelff,Hardpan ❑ Previous Application Made: (If yes,date--------------------) No) New Construction: Yes ❑ No_'K,, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public wer is available within 200 feet.) � o Septic Tank: Distance from nearest well-8---_ --------Distance from fpaion--/1�__-------.MaterDial-----------------------------•.__:___- -----. No. of compartments-----� .._. .. ,--------------Size-- _- _ _Fr _ - _ Liquid depth.---.--19---------Capacity.. Disposal Field: Distance from nearest well! - `tt Distance from foundation-C......--Distance to nearest lot line....._,t�.._ ! Number of lines-----d----_.- Length of each line- _-- 1R3_'''---___.Width of french.----_.�__�l� ----------- Type of fii.ter materiaa .--Depth of filter material------- length-.---_��_-Q__!�----------------------- �. Seepage Pit: Distance to nearest well-.--------------------Distance from foundation---.....-----------.Distance to nearest lot line... ❑ Number of Pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------------.--------___-:- Cess Doli Distance from nearest-well-----------------Distance from foundation--------------------Lining material---------.--------------.._.-_-----._. ❑ Size: Diameter--------------------------------------Depth--------------------------- Lrgwd Capacity---------------------------gals. Privy:- Distance from nearest well-------------------------------------- ------ --Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line.........------- ---------- - ----------•----------------------------------------•------••------••------------•------- ------------ Remodeling ---------Remodeling and/or repairing (describe):------- _ _ _ -t-- '+ ............. ---------- -•- ------ I AL --- -- - -- ---------- oe— _ --------- -- --- ................. --------- ----- = = I hereby certify that I hav preppa d this applid ion and that the work will be done'in accordance with San Joaquin County } ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. ' I `q �: 4 . � ------- -------------------------------- By: ------------------- - ---------------------- - 4Contractor) ; (Signed) By:---------------------------------------•---•--------------------------------------- ------------_(Title)------------------------------------------ ------------------ (Plot plan, showing size of lot, location of system, in.relati o wells, build' gs,-etc:,-can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-.--- `�-- ----------------------------------------------------•--•--- DATE--------_;I = ^� REVIEWEDBY------------------------------------- ----- ----------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------—----------------------------------.--- DATE------------------------------------------------------------- Alterationand/pr recomme dations--- ------------------------ _...-- ----•-----------------.------------------------------------- ZZ _e -- -------------------------------------------------------- ---------------------------------------------------- -------------------------------------------------------------------- ---------- ... FINAL INSPECTION BY: - 't "" Date--- - ----------- r L -------------------------- 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 E8.9 REVISED 0.59 F.P.CO.2M 6.60