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FOR OFFICE USE: 41P -------------------------------------------------- -""-"- ----- -------------" ------------ APPLICATION FOR SANITATION PERMIT Permit No. ..I.....-3 ------- ------ -- --------j _ � �-----d---�v-- [Complete in Duplicate) 7-.- -. e--.-- ' -- _ -- Date Issued __ ----� -- ----_------_ ."..--__.""-. ------------------- This Permit Expires 1 Year From'Date.Issued. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. ------------ JOB ADDRESS AND LOCATION-- `t [�u•• '----------- Owner's Name------ '� -rte------------------ ••-------•---- •-•- -------------' Phone Q-�- � Address { f �` - ------------------------------------------------------------------------------------ `� ` j7�', Phone Con#ractor`s Name. t -• -------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' ii Number of living units: ..--- Number of bedrooms _ __ Number of baths /---. Lot size __spa..p, _pp ------------------••- Water Supply: Public.system [Community system ❑" Private ❑ Depth to Water Table _ 4. ft. Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tardpan ❑ Previous Application Made: (If yes,date---- ------,--------) No New Construction: Yes R No ❑ FHA/VA: Yes p--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i ,p Septic Ta k: Distance from nearest well----"- _--.__Distance from foundation----lQ.-------Material_ No. of compartments--.--p2i_.____.-."____.5ize-{ � _ ----Liquid depth---��"/--------__capacity... le Disposal Field: Distance from nearest well--..* " ---.-.Distance from foundation.----1 -_---.Distance to nearest lot lin e_a7...... Number of lines---------. --__--__Length of-each line----__- _ ---__--.- Width of trench---.s i Type of filter mat �, �1j6-Depth of filter material-" !-f_--_Tota{ length___"----- ._�_________________'___ Seepage it: Distance to nearest well__-- ---Y Distance from foundation_-_:/. __.._--.Distance to nearest lot line---6 --------_ Q a. Number of pits-------,1-----------Lining material__ �G _.Size: Diameter. -- Depth---- ----- Cesspool: Distance from nearest well"----------------Distance from foundation___----------------.1 fining material.-.---------.-------._.."-___-__-.._. ❑ Size: Diameter--------------------------------------Depth------------------------=--------------------------- Liquid Capacity_.-----------------------gals. Privy: Distance from nearest well----------.-"---"--.___-------- ---------------Distance from nearest buildin El Distance to nearest lot line----------------------------------------------------------------------- --_------------------------g -••---------------• - -g--'-------------------------''----------- Remodeling and/or repairing (describe):------- ` Lw ------•--•--------------•-•--------------------- -• ---------- .; - f --------------------------------------------------------------------- I "---_..."._ "_----_-----------••---------------------------'"-..----- . _"--- -._ --"-. _"" -- - - ----"____---------.-._."----------__-__.........._--------.------.-..----_---------------_----___-... -"-----___" - I here-by"_"certify._ --th-at----- _ I have p.repared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations 'of the San Joaquin Local Health District. I ��/or Contractor) (Signed)_ -- By: i -------------------------------------(Title)....A,_E Ix _ __ - - ---------------- (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ DATE------ ! " - REVIEWED BY - ------ ... - DATE - ---------- '-------- BUILDINGPERMIT ISSUED---------------------------------------- ------------------------------------------------------------- DA-Te------------------------------------------------------ Alte�rfuo s and/or � recom nda'Pions--------------- -""S-. - ---- T --.`-•---------•-----------------------------"-------- ' =7 . ` C ----- / =l_ -.. ----•-2Z__ � ------------------------------------------------ ------------------------------------------r---------- ---------- j---- ------------------•------------------ -------------------------------------------------------------------------------- • --------------------------------------------------------------------------------- ------------------------------------ ------- --------------------------------------- --------------- i FINAL INSPECTION BY:.--- - ' Date------ -' . --- ' ' i ty�t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerlc*r Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California x Y t Manteca,California 'x Tracy,California t EB-9 Rcyleco 0-59 F.P.ca.•2M 6.60