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FOR OFFICE USE: �0 -z / -- --------- I L APPLICATION FOR SANITATION PERMIT Permit No . 2 ��-......... ------------------------------------------------------ (Complete in Duplicate) 2r -"This Permit'Ex fres 1 Year From Date Issued Date Issued ____I:,_: �..__ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... Gr'`'------Jnli_.%G--- Owner's Name------- ---=.-.._-----------•--•-------------------------------- Phone -------------- ---. -----------• -- Address_______ f ...----....-•------••••--•----------•------"'--•-•------------•--------•-- E ..-__ --------- m` `rte~ Contractor's Name''tf =------•-------------------•--------------•---------------•--..._.... Phoneys ��frFl"r.._. r Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____'Numb-er of bedrooms _i Number of baths _,%___ Lot size .._.-_ c ___" �,-/ ----------------- Water Supply: Public system ❑ tCommunity system ❑ Private Z Depth to Water Table P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeV Hardpan ❑ Previous Application Made: (If yes!date____________________) No ❑ New Construction: Yes W No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: INA (No septic tank or cesspool permitted. if public sewer is available within 200 fe6t.) _ Septic Tank: Distance from nearest well ... Z�_:Distance from foundation --�p�_-- Material ____ @_ ------------------ i No. of compartments --------- R-7�--------- @Size__:__.9.k--- Liquid depth__�`_a_y�---___Capacity --- ___._ ' Disposal Field: Distance from nearest well..!'_'Distance from foundation. ---l0. ----Distance to nearest lot line.... - ------- R, Number of lines--_________.�--------------- length of each line ------------------------------ Width of trench -------- ---�----------- Type of filter maferial_�T �_c :_-----Depth of filter material___ _B' �!._-_ Total length --------- :- -------------------- Seepage Pit: Distance to nearest well --------------------- -Distance from foundation -------------------- Distance to nearest lot -line ----------------- El of pits____________________Lining material______ --__._____?--_.Size: Diameter----._--______..______--Depth______-__-----___.______________- Cesspool: :Distance from 'nearesf well_______'_-..-- Distance from foundation --------------------Lining material___.______-----.--_____________ --._.. ❑ Size:, Diameter ---------------------------- Depth Liquid Capacity gals. Privy:. Distance from nearest well ----------------------------------- -------------- Distance from nearest building ------------------------------------------ 0 � . h � _ `Distance to nearest lot line ---------- ----------------------------------- -------------------- ...._._..------------------------------------ -- -•---------------------- Remodelingand/or repairing (describe) --------------------------------------------------------------------------------- .-----••---•-•--------•----_--.----------------•-•---------- --•--- i --------------••-----------•--------------------•---------------------------------------------•----------------------------- I --------------------------------------------------- ---------- I-•--------------------------------------------------------.----- e------------------------------------------------------------....-------------------•------------ ---------------`-----=-------------------------••----------------------------------------------------------------------------------------------------------------------•---------------- ------ I hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed/_�f.�..l----------------------- -(Owner and/or Contractor] gY:------••----------------------------- ••-•----------------- -----------------=------------------•--------------------------------- (Tits)----- •-- --------.-_._.. -------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, ete., can be placed on reverse side). FOR DEPARTMENT USE ONLY --. APPLICATION ACCEPTED BY = ---------=----------- DATE -! REVIEWED. BY --------------------------------- ---_---- ------------------------ -:-------------------- DATE' BUILDINGPERMIT- ISSUED---------- ---••-------------------- --------------- DATE ------------ .-------------------- :--•--------------------- Alterations and/or recommendations:: ==--•-•----------=----••-------------•--------••------------------•----- ------- ------------------•-----------------------------------------•------------------•-----------------------------------•-••---•------------------------.---------------------------------------: ------------------------------ ------------•------------=------------------•- `--------•--- ---------------------- ------------ --------------------------------------------- ------ -- -----•---------------------------------•--------------------•--•------------------------------------•----------------------------- ----------------- 4 �/. --:._. , r �� Z FINAL INSPECTION BY Date 7 ----------•- - -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lod], California E9.9 REVISED 6.59 F.F.C13. 2M 6.613 124 Sycamore Street 205 West 9Th Street Manteca, California Tracy, California