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. .rvr Vrric.t USE: y '`{------------- [ - :; t----------------- - -- � t_ --- -____ APPLICATION FOR SANITATION PERMIT - Permit No. _ ?-`{_ -.-_-- --. (Complete in Duplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date issued __� - -�' �{Dp 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 Ordina a No. 549. JOB ADDRESS AND LOCATION------ —7 AAL, Owner's Name____ _ ____ _____ •_ Address.--------... ----- f---•----•--•-•---•------------------•------ ----------- Phone------------------------------------ ____--_ _ . Contractor's Name_____ ___.._------ .... .. .---f----=�------------------------------ -------------------------- Phone-,--------------------------------- Installation will serve: Residence [J �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___- umber of bedrooms _�Number of baths _ .___ Lot size .'7-�-._X j / D Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table XJ ft. '. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er Hardpan ❑ Previous Application Made: Ilf yes,date....................1 No ❑ New Construction- Yes ❑ No [I PHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep is Ta :, Distance from nearest well_________________Distance from foundation--------------------Material _.____..--____._._____-____________--_______.___. No. of compartments--------------------------Size---------------------------------Liquid depth---------- ----- -------.-Capacity------ -•-------------- Disposal Field: Distance from nearest well-----------------Distance from foundation_____-.._____-_-___.Distance to nearest lot line__--____-__-___-- Number of lines-----------------------------------Length of each line-•-----•----------------------Width of trench Type of filter material-_________------_-------Depth of filteDun l___-._____--______-___Total length------------------------------------------ Pit _____________--:____________---__ r Seepage Pit Distance to nearest well !" ----_---Distan fromion p_.--.. ___ Distance to nearest lot line_.3Number of pits-------I-------------Lining materi .Ge: Diameter-------�_�`..-- _-__Depth---4sr -!.----------- Cesspool: Distance from nearest well__________ ____Dista ce fromion------___-__-_____.Lining material____._.___.________--.______ El Size: Diameter--------------------------------------Depth---------------------------•----------- -----•-----Liquid Capacity--------------------•--------gals. m - Privy- Distance from nearest well-------------------------------------------------Distance from nearest buildin m g ------------- ❑ Distance to nearest lot line-------------------------------------------- Remodeling and/or repairing (describe):__________________ _ I hereby certify that I have prepared is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' g ations of the San Joaquin Local Health District. (Signed)-------------------------------•--- ------- ----_-(Owner and/or Contractor) By:-- rifle --------------------------------------- -------- - a plan, showing size of lot, location of s st m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___0=--- --------- _---_y�-t--- -- ------------------� i-� ---------- ------------- DATE- REVIEWED VIEWED BY ----------------------------------•------ ------------------••------- DATE.-------------------- BUILDING PERMIT ISSUED----------•------------------------- ------------------------------ ------- DATE_.. Alterations and/or recommendations:.------------------- ------------- ---------- -------••-- 4 ------------------------------ -- ----- , --------------------------------------------- ------------------------- ----------------------------- --- ------------------------------------------ - -- FINAL INSPECTION i3Y:.- - = -i ':.-e Date �11• F �'i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REyiBED 8•59 F.P,C O.ZM B•SO