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FOR OF IC USE: ' ° 6 ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ...............z.:. ----------------- ----------- --------------------------- (Complete in Duplicate) --------------- This Permit Expires 1 Year From Date Issued'. Date Issued Application is hereby made to the San Uoaquin Local Health istrict for a permit to construct and in all the work herein described. This application.is made in compliance with County Ordin a No. 549. ��LL`/ -•-•---•---- f ----- ---- -------• - - -- ------. --•------ ----••-- JOB ADDRESS AXD OCATION------__.✓_______� __-.-_-__ --- Owner's Name------- --- = phone.. Address----------------- --------- --- •- -- } 1 - - Ic ----- Contractor's Name___/i- - - ---- ` �i --< ----:- ka-----•--•----- Phona Installation will serve: Residen ceApartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: 2f__ Number of bedrooms --�Number of baths ---I—Lot size ----J74-- �---...1---®____ ___ _____ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .�_3?ft. Character of soil to a depth of 3 feet: Sand-E) Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay El Adobe , Hardpan ❑ Previous Application Made: (if y.es,date-----------_---------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within, 20Q feet.) Distance'from nearest 'Well-----------------Distance from foundation___________________.Material______._.___._.____-__---_____________-____-____. No. of compartments----------,�---i-------------Size-------------------------------Liquid depth-------------------------Capacity------------•---------- o Kiel Distance from nearest wellj4Vta1.e__Distance from foundation ____AO_____.Disfance to nearest IQt line_____'��-.. p Number ofr'lines____�------__ ________ Length of each line i Width of trench.__-..---_2 _ Len pp . '�}� of filter material_ x__ __Depth of filter material_______�_�y__��____Total length_ � .._17�________ - ` IF ------ Type See a e Pit: Distance to nearest well-.,14 C't__ :Distance from oundation_____[_�____-__.Diistance to nearest lot line__..._-1--.-- _j - ._ --i Number of,pits ___�___'____.._-_`__Lining material._Qom. _ -_--- Diameter----3-3 Diameter__- -.-.____Depth------ 1 r, 4.. Z Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__._______.___-_________.____-._____. ❑ Size: Diameter--------- ---------Depth------------------••---t----- ---------------------Liquid Capacity--------••------------------gals. PPrivDistance from nearest well_- _______________________._._Distance from nearest building---___________-_--_____________________._. rivy: ----------------------------- . ❑ -Distance to nearest lot line---------------------------------------------------------------------• ---•-------------...----------------------------•----------------- Remodelingand/or repairing (describe)--------------------•------------- ------------------_-----------------------------------------------------------•--••--•---••-•----------•----------. - I ••--------------------=--------------•----=----• -----------------------------------•----------------------------------------------- = .---------••----- •- --------•-•----•--•-------------------•--•--------------------•-•------ -•----- ------ - ii ------------•-----•----------- --------- -- -------------------------- -------------------------------------------------------------------------------_---------------------------------------------------------- I hereby certify that I have prepared this appiication`Ad'that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and requlations of the'San Joa uin Local Health District. (Signed a---- - -- - � - a a /s, -- ----- •-• ----- ------ Contractor) ------- By: -----------------•--•---------------=-----•- :-----------------------.------- ----------- - -----(Title)---------------------------------------------...- ------------_. Y•-- (Plot plan, showing size of lot, location of system in relation to ildings, etc can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY 11, jLAPPLICATION ACCEPTED BY ,• DATE l �� 1 -< r ' DATE--------------------•--- REVIEWEDBY----------------- ---------------------------• -----------------�------------------------------------------------------------ --- -•--••-------------=-------.. BUILDINGPERMIT ISSUED----------- --------`--------------- •---------=-•------•-•------------------•--------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:-- ----------------------- =--------- •••------•--•------------ --------------------------•------------------------------------------------- ... -------.. ------- ----- ------ -- -» .. --- -- ti __.. ---------- -- -----------I -------------------------------------------------- lJ�f R .t FINAL INSPECTION BY:..t Cr'"__.'� Date---- �. Q ` �� ---------------------------- 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 ES-9 REVISED 0.59 F.P.CO.1M 6.60