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FOR OFF CE SE: ' b ------�------ APPLICATION FOR SANITATION PERMIT Permit No. _ I- ---------------- ----------------------------------------- --L_`---`F ----------------------------------------- --------------- (Complete in Duplicate) t �P Date Issued .___ -------------------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 AN C TION._._ , --.LIQ------_-,. - -- -:-- --- - -------------------------- Owner's Name--------- -- Phone---------------------------- Address----------------- ----- � '' Contractor's Name----------------- -- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: ._.. Number of bedrooms l- Number of baths , Lot size _ - —-------------------------- Water Supply: Public system ❑ Community system ❑ Private �epfh .fo Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [1 Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe g4-'5ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: YesNo 2j'01FHA/VA: Yes ❑ No 9?-" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepW/W Distance from nearest well-----------------Distance from foundation--------------------Material-_._____-____-_______.__---..---__________-__. No. of compartments--------------------------Size------------------------------:Liquid dep..th------------ -------Capacity----•-------------•--• C31. Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line--------.-------- V) Number of lines-----------------------------------Length of each line------------------------------Width of french------------------------------------ -Type ---------------------------------- Q— � �� _Type of filfer material-_______________ _ ____Depth'of filter material______________________Total length---___.__ _-.-_-.--_---_-_.__---_ _.__.- �t: Distance to nearest well-_/��__� Distince fr fou dation__��__"..Dista �o nearest lot ling,a�.~____ CA Seepage Number of pifs----�____________Lining material._j1� 5ize: Diameter____'` -_ Depth__- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation_---_----------------Lining material__-._-__----_-.__-_.______.___-___-__. E] Size: Diameter------------------------------•-------Depth--------------------:--------- ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------_---------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line---------------------------- -- ---------------------------------------------------------------------•------------------------------------ emodel ng and/or repairing [describe)-------- ----� •-•----•-------------------•----------------------------------------------- J �.:. � ' I --------- - J� --- - --- y�f p 4 p ✓llL2 S �L � C�wl.-'-- �LS�•- C f�`f�l----- ' Gam--------- -----------------------------�----------------------------------------------------------------------'--•------•---------------------------------------•- ----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rales and regulations of the San Joaquin Local Health District. -- �— (Signed) - - 1 ------, (fir Contractor) `' Tifile �y= -- ---------------( ) - j---- ..-- -------------- (Plot plan, showing size of lot, location of sys n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------ DATE ` 9 �f REVII WED BY ---------------------------------- - ---------------- DATE------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------- ---- ----------------- DATE--------------------------._-------- ------------------------ Alterations and/or recommendations: ----------------------------------------------------------------------------------------------•--------•-----•----------------..-------------•------- - - ----------- --- -•------- ---- ----------- ---------------------------------------- ---------- -v- --� ---'- -- •_Gtr-� -------------------------------------- - ------- ---------- - ---------- - ------------------------------------- _ - - ----- - ------------------------ FINAL INSPECTION BY:.-(c---cr--- — -- -- - Date---------/-_—_-J-t."_�__� ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street . . ��1+24 Sycamore Street _ 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 99-9 REV18E4 B-59 F,P.CO.2M 6-60 I 7