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------ --------------------------------------_--------- APPLICATION FOR SANITATION PERMIT Permit No. ------ --------------------------------------------- --- (Complete in Duplicate) 6 This Permit Ex ires 1 Year From Date Issued Date Issued ____71 ) 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 Ordinanc No. 549: ! JOB ADDRESS AND OCATI N_ .0---6 - -_O- Y+-F._ ---- ---- - ---- ------- Owner's Name--_- -----2.-- -- -- ------ ----- --------------------- -- -------------. Phone Address------------- --- -•--- --------- ---------•--------------------------------------- -------------------------•------------------------- Contractor's Name___ S ------------ --P--••---------------------0 ----------- Phone. Installation will serve: ;Residence ��A artment House Commercial [:1 Trailer Court ❑ Motel ❑ Other Number of living units: _"l_____ Number of bedrooms _ i ❑ t Number'of baths -_.1___ Lot,size ater Supply: Public system E] Community system ❑ Private P�epth to Water Table l_jC5ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`[j--Ka'rdpan ❑ Previous Application Made: (If yes,ldate---- ..._.. _- _--) No [ New Construction: Yes No 1 ❑ �FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t `� 1 Sepfi nk:� Distance from nearest well_________________Distance from foundation_-.____---______.._Material No. of compartments--------------------------Size---------- ---------------------Liquid depth-------------------------- CapacitY ------------ Disposal Field: istance from nearest well------------------Distance from foundation________._________-Distance to nearest lot line____"_______.." ❑ umber of lines-I-------------------_-----_------Length of each line-----------------------------.Width of french---------------- "-"-- Type of filter ma'erial-------------!_-_-------Depth of filter material----.-----------------Total length--------------------I--------------------- Seep_age/�rt: Distance to nearest well__1a70_____________Distance from fo dation1 _( Distance to nearest lof line___ v L(d� Number of Its..�__ p F -------------Lining materia- 1_-- --__ --- -- -Size: Diamefer.---"-- - �-�----- Depth --� ------- ----- Cesspool: Distance from nearest well_.__--____-_.__Disfance from foundation____________________Lining material____..._--___________-.._________". ❑ Size: Diameter._)----------------_- !I Li uid Capacity - Depth ---------- ------------------- q ----------------------------gals. Privy: Distance from nearest well _____------""- ------------------ - - j.)._Distance from nearest building El r g Distance to nearest lot line... .__________________________ II ------------------------------------ J: ------------------ Remodeling and/or repairing (describe):__"_______________" ----------•--------------------------------------------------- -------------------------------- --------------- -------------------------- - ----------------------------------- ------------------------------ ----------------------------------------------- •------ •----------•-----..---- I hereby certify that f have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I[ s,'and rules_,and reg ations the San Joaquin Local Health District. (Signed)__________ __ ___ ' -_____----------(Owner and/or Contractor) � y y � .F $y:--------------------- ---------------•--- _�i Title (Plot plan, showing size of lot, Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). n! I FOR DEPARTMENT USEONLY APPLICATION ACCEPTED BY____(Z__ --------------- - ------------:----------- DATE------ REVIEWED BY-------- ---------------- - ------------------------ BUILDINGDATE PERMIT ISSUED--------------------- ------------------- --------------------- --------- - ---•----- ----------------- A E and/or recommendations:._�--"?r.�-. �,�' )�'"-.-.--." --------------- Alterationst"`�- ________________________._---------------------------------- li _.____-__________"_.___ f ------------------ ------ ----I--------- -------------------- - --------------------------- ----------------p --------------------------- ------------ ---------------------- I: FINAL INSPECTION BY:..___ Date Z ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cd.