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FOR OFFICE U�E: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ........................ --------------------------------------------------------- (Complete in Duplicate) 7/ o Date Issued .....__.--l..__..___1116x- ------------------- --—-—-------------------- ___..___________________________________________.___..___ 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 AND LO TIO --- •-•-- f. t Y Owner's Name----------------- --- ,GJ y� e °" - ------------- 'Phone--- ---- Address-------------------------------- ::.. C� --•-------G�--:-•--/ � ! Contractor's Name____________ __ .______ - - ------------------------•---------------------------------------•--•----- Phone..........................-------- Installation will serve: Residence ❑ Apartment House ❑// Commercial ❑ Trailer Court ❑ .M�po�tel ❑ Other ❑ Number of living units: __/r___ N ber of bedrooms _/____ Number of baths __/.-- Lot size.___r ._ :__ /_e.q_________________________ Water Supply: Public system Community system ❑ Private epth to Water Table _/,2ft. I Character of soil to a depth of 3 feet: Sand El-/Gravel ❑ San Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2, 4arclpan ❑ Previous Application Made: (If yes,date__..-_-- 1 No New Construction: Yes ❑ No Q�,,<HA/VA: Yes ❑ No 9--_ - a TYPE OF INSTALLATION AND SPEC IFICATIONS:I I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------L___Distance from foundation-------------------Material __._.-____________._._____.__._-.-------------- No. of _-------____.No..of compartments--------=--- Size-----•-•--=-_„"-7=�=bquid depth--------------------------Capacity----------------------- t ______________Distance from foundation_-._._.________.__.Distance to nearest lot lie________-__---_-- Disposal F Distance from°�earest we�IL_ � J Number of lines________________ _______________Length of each line____" --___---..___..Width of trench__ _ __. ------------ - ---------- i Type of filter'material_'-r-,-e-L- ______Depth of filter material---jj__�;---------Total length----- -------------------------- y Seepage Pit- Distance to nearest well-0 'Distance from fouridation____.,��?_/___.Distance to nearest lot line- ---L��y Number of pifs_::__/---------------Lining material-----Yti_5;t_k?.Size: Diameter.___ .r Cesspool: Distance from nearest well----------------- 'Distance from foundation,--------------------Lining material-------------------------_----------- M ❑ Size: Diamete'r--------------'-J- --------------------Depth-------------------- ------Liquid Capacity---------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----_---__.__------------------------_.._. ❑ Distance to nearest lot line-------------------------------------------------------- --------------••----------••--------------------------------------------------- O Remodelin and/Mr r airin� (descri4)_-----_------------ �(,,� d.� -- - - ---------•• - ------------------- ------ --•------------------•-•----•------------------------• ----•-•-------------------------•---------- -------------------------- ------------------ -------------------------------------------------------------------------------------------------------•-•----------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lays. and rules and ulations of the San Joaquin Local Health District. Lab = {Own and/------------------------ (Signed) r Contractor) B A -------[Title)- •�---- --- ------•---Y• ----- [Plot plan, showing size ot,.locati n of system to relation to wells, b ' S, etc., can be placed on reverse side). FORDEPARTMENTUSE ONLY l APPLICATION ACCEPTED BY-- 4 ` x DATE-- -f�� -------------------- REVIEWED BY------------------------------------------------ - DATE BUILDINGPERMIT ISSUED-------------•------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alferaions nd/jor recommendations:-----------------------------------------------------•-----------------------------------------------------------•----------.------••---•------•------..------ - - �- _-- ; ----------- --• --- -- --- �- ------------- ---------- -- -- ---�- - -------------- ----------- -------- --------------------------------------- -- -------- ---------------------------- ----------------------------------- ---------------------------------------------------------------- FINALINSPECTION BY: -------- - ----- ------ -- --------------------------- Date---------- '7---•----------------------------------••--- j tSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 114 Sycambre Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E8.9 REVISED e•89 F.MCD.2M 6.60 -