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--� - R OFFICE USE: � is _��- - -11- �• ______________________ APPLICATION FOR SANITATION PERMIT Permit No. ---- 7 ` -----------�---------*------ ----------- - - (Complete in Duplicate) -- -------------------------------------------------------- This Permit Expires 1 Year From 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 LOCA ION___________________7q-_� •-��__--��i�'i!/1- /� Owner's Name --- -'r--5�_:_..6 1l- -------------------•------• ---------------------------------•--------------- Phone."Vo Address ---------- K -•---------------•---••------------------------ Contractor's Name----------------------------- -�- ---- 1---_--- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___rNumber of bedrooms --2- Number of baths ________ Lot size ----�1 . --_X_. j-�__/------------ I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .-!V-?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f Hardpan ❑ Previous Application Made: �(If yes,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 200 feet.) Septic T nk: Distance from nearest well--- Distance from foundation___________________Material_______________.____________________-___..______. No. of c --------_'._-___Size______________________________'Liquid dep'h---Distance to nearest lot line___ _j. ¢ Dis osal Fi : Distance from nearest well____ _. -__Distance from foundation-----/.0_ __. Number of lines_____________ ____ - __Length of each line____________�� _�_._.Width of trench--------- _`.._ ------------ ,,// .. of filter material-- ------------ Seepage of filter material____.___._ 0�_Total length--------------- Type j--------- ._ ----- Seepage Pit: Distance to nearest well_________.-_.__Distan foundati ___,C�Er_.__.Distance to nearest lot line____--y ~_!- p �_''�___L`inin ma rial�G_, �f Number of. its-- ------ 9 ,�^_Si Diameter_ Q �� Depth Cesspool: Distance from nearest well------_____.___ Distance from dation___________________.Lining material-_-.--__.__.__________-_______----_-- ❑ Size: Diameter '-------- Dep ------------------------------------Liquid Capacity---- --------------------gals. Privy: �; Distance from nearest well-------------------------------------------------Distance from nearest building-__-----_____________---_____._______._. ❑ Distance to nearest lot line--- -- ------------------------------------------------------•--- f Remodeling and/or r pairin escribe):_______= A "d_._- -.. -- 'r•! ---------- ---- _- _ -__-- --- •-------------------------- ._.._... ------------------ - - �---- = - ------- 1 _ _ /nandlhat_t�, _ __ __ _ Y _ _ ----------- �� ..- -- ! hereby certify that I have prepared this applicati work will a done' accordancaJoaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- -- ---=----------------------------------------------• - :. - -------------------------------------------------------------------� --------=-(Owner and/or Contractor) - By:----------------------------------------------------------------------------------------------------------------------------------.-(Ti+le)---•-------------•------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U5 ONLY APPLICATION ACCEPTED BY----------- ZZ ----=------ DATE---- l REVIEWED BY-------------------- ----------------- ------- f -------------------=--------• --------------- DATE----- ------------------ BUILDING PERMIT ISSUED-------------------------------'�---- - : ------------------------------------- DATE---------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------•--------------••---•-----------•------------ -------------- •---•----- / ii --------------------------- ----------------------------------- 17 __ ________ ________ _____ __________ _ 'V"------------ -------- - -- --- ------ -- - -- f'?___� -----•--------------------------;-------------------•---•- -- ------------- FINAL INSPECTION BY----- ---------- - - -- --- -- - ---- -------- Date--r. --------------------------- 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 E9•9 REVISED 8-$9 F,P.CQ,2.6.6D