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nFOR FFI.C,ft US GAF yJ•�G �(----- Id - ------------ ---- APPLICATION FOR SANITATION PERMIT Permit No. ...1.3d.... ----------------------------------------------------- -- {Complete in Duplicate) This permit Ex fires 1 Year f:rorrl 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 LpCATION--.------- . , _�-- _ _ . ,� Owner's NameQ_ �s[�/ _A��Lf _.. ----- ----- Phone Address__. ----- .: ------ ••�-�' ,efi-- - ..�.1_�: ��..-----• Phone.----__-- ---- - --- -- ---- Contractor's Name______'. :__/ Installation will serve: Residence Apartment House ❑ Commercial D Trailer Court ❑ Motel L] Other ❑ ' Number of living units: ____Z_ Number of bedrooms _ _ Number of baths _4 Lot size _____�? X__ _________________ Water E Supply: Public system K Community system�❑ ' Private ❑ Depth to Water Table .�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date________ ___-----___) No J� New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a(No septic tank or cesspool permitted if public sewer is available-within 200 feet.) �S i� T tk�. Distance from nearest well__------_--------Distance from foundation_______...-_-______-Materia...____________.__--_.________----_.-____._____. rS / rsNo. of compartments--------- ---------Size---------------------- __Liquid depth-----------...............Capacity Disposal Field: Distance from nearest well-_ Distance from foundation--/V ... Distance to nearest lot line__.�J....___ " Number of lines______#__l_______________---_--_Length of each line___/Q____:__'. _ Width of trench.-- � ,✓� -�--------- Type of filter material____ Gl�____Depth of filter material____ ------------Total length______1)._�___________________ _. „,. �...... .,. f ee Pit: Distance to nearest. ell__/eVAtr•,__Distance fr m foundation-_ _________. �` �� --- --. - ,i� �� .,_ Distance to nearest lot line--.,.5 rte/ p (_ A Number of pits'__�___.___-_ ____Lining material_____ _ -.__ _.Size: Diameter___ . --- __De th____..,?_L '___________ t� t Cesspool: Distance from nearest-well:---------------:Distance from foundation------------------- Lining material---------.-__-.._______________-_-_-- ❑ Size: Diameter #----------------------------Depth------ ------- --- -----=---------------------Liquid Capacity gals. i Privy: Distance from' nearest well________________ ________._______`-___ _f-_Distance from nearest building____:______.-_.___________--_--.--.__----- ❑ Distance to neare4 t lot line- ------------------ =---------------•------------------------------------------ -------- Remodeling and/or repairing (describel- - "- l l� f ------- i .----•---------------------- ----------------- •-- - -- �------=- �- ` ------------- ----- --� -----------------------------------------------------•----------------------------------------------------------------------------------------------------------- ----•--------------------------------- - ------ I hereby certify that I have prepared this lication and that the work will be done in accordance with San Joaquin County ordinances, State laws,' d r s and r atio of the San Joaquin Local Health District. (Signed) ;�- - --- ------- ---- (Owner and/or Contractor By: ------------------- -- ------- (Title) _ - (Piot plan, showing size`of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �J z - b _.� - �� ----- -- --- ------------------------------- DATE----- � APPLICATION ACCEPTED BY... ` REVIEWEDBY---------------------------------------------------------------------- ------- ------------------------------------ -------- DATE-----------------...' BUILDING PERMIT ISSUED - DATE Alterations and/or recommendations:-----•--------------------- -----" T:.. = k --------------•---•-------------------•-•---------------- •--------•------------•-----------------C--------------•------•------------•-------------------- -----------•--------------- -----•-------•---- ---- --------- --- ---------------------------•- ------ FINAL INSPECTION -____ .... ---------------------------------------- BY: ~ z —�� -`•-- -- --- -- -------- ------• Date----- •----- •-�--------------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street i 24 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California E8.9 REVISED 9-59 F.P.00.2M 6.60 - 1