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FOR OFFICE USE: 3o �`_D-4 -6-2- �3� � APPLICATION FOR SANITATION PERMIT Permit Na... ------------------------------------------------------ (Complete in Duplicate)- ____________________________.________.__.__._.___ ""'" This Permit Expires 1 Year From Date Issued Date Issued ........,.___. Application is hereby made to the San ,Joaquin Locale Health District for a permit to construct and install the work herein described. This application is made in compliance with- County Ordinance No. 549. fid•-5r� -+ JOB ADDRESS AND LOCATION ; ---------------- Owner's ------- tih��------------------------------------------------- Phone ---------------------------------- - Address----' �L�_..__J�s- ----- �''�----------- jl ` Ci % `. --------------------------------------------------------------------------------------- Contractor's Name..,'' --r'-•-------------------------------------•-------------------------•--.--- Phon�1_�a'_..� �. , Installation will serve: Residence [Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of bedrooms � -_ Number of baths ._,!___ Lot size ____-___ �rr��i �-- �Number ofJiving.units: ___�_. -- ---•-••---- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to WaterTable_-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes, date --------------------1 No ❑ New Construction; Yes [r No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [ �_ (No septic tank or,cesipool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.__ .__ Distance from foundation___!® ® No. of compartments ------------- _..------ Size ---- _�L,X_. _x_S___Liquid depth ... ---`'.Capacity.._. mat Disposal Field: Distance from ne6rest4w ___�a__.Distance from foundation______Distance to nearest lot line_____ J_—_.-_. N Number of lines_____ :____________Length of each Iine:J-g___-Width of french ---------- ................... Type, -of filter material__._f7aZ,_/,._Depth of filter material ----- _f7 -`'___Total length --------- /��______________________ Seepage Pit: Distarice to nearest well ---------------------- Distance from foundation -------------------- Distance to nearest lot line_ .............. I❑ . Number of pits ------- :--_____------ Lining material ---------- ------------- Size: Diameter ------------------------ Dept h-_------------------------------- Cesspool: Distance from nearest well ----------------- from foundation -------------------- Lining material. -__-.__________-___.___.-______._... -.__ :.❑ r.� ......Sae:,. Diameter-------------------------------------- Depth -- ------------------- -------------------- Liquid Capacity- -------------- ••-------gals. ' Privy: Distance from nearest well_ --___________ __ ___ ------- Disfiance from nearest building------------------------------ ❑ Distance to nearest lot line ----------- ------------ --------------------------------------------- I ------------------------------------------------------------------ Remodeling - -----------------------------------------'------------------------- Remodeling and/or repairing (describe): i t 4 — . -------------------------------------k-•-----------------------�-----------------�--------------------------T�----------------------------•---------------- -------------------------------------------- I hereby certify that I have prepared this application and that the work will be done Waccordan'ce"with.San, Joaquin County ordinances, State laws,and,rules and regulations of the San Joaquin Local Health District., - I-.. ------- I ------------------------------ ------------------ Owner and/or Contractor (Signed}------------------ ---*-•_---:�-------------------------------- - � ( / ----------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on .reverse side). -` FOR DEPARTMENT USE ONLY �V APPL-ICAT4Q-N,ACCEPrTED B ---------------------------------- fes_ ---�-- REVIEWED BY -------------------------- ---- BUILDINGPERMIT ISSUED ------------------------------------------------- ------------------------------- =---------------- DATE ---- -------------- - .. T Alterations and/or recommendations:_________________________________ --------------------•----------------------------•-------...---------------------------•--------------------------------.---------- ------------•--------------------------------- ---------------------•-------------- -------•-- ----- ---------•----•-------------- •--------------•------------ -- •--------------------------------------------------------- ------------- ------ •----------- .................... -------------------•------•-•--------------•------------------------------------------•--------- - _ ------------------------------------------ Date -------------------------------------- -, O Date--------20FINAL INSPECTION -BY:.--__ ------ --- 41L :.-------. -- SAN JOAQUIN LOCAL HEALTH DISTRICT -� 130 South American Street Stockton, California E6-7 REVISED D•59 r.P.DD. ZM 6.6P 300 West Oak Street Lodi, California 124 Sycamore Street 205 West 9th Street Manteca, California Tracy, California