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FOR OFFICE USE: -- - ------------------------------------ APPLICATION K)R-SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) _Z__ Date Issued ...?A&I(e. _ ------------------------------------------ -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Di-strict 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 LOCATION..._.. ...... -------------------------------------I.............I............................................ Owner's Name------- ------------------------------------------------------------------ Phone----------------------------------- Address..' ................ Adclress..'14. ...............: ......................... -----------................... .....................................................................I................ Contractor's Name=-----=-=----------------------------------------------------------------------------------------------------------------------------........ Phone...............,--•--------------•- Installation hone..........------------------------ Installation will serve: iResidence C] 'Apartment House [] Commercial [] Trailer Court ,Motel ❑ Other E] Number of living units:."/----- Number of bedrooms ---/ ----- Number.of baths Lot size __- -----------_------- Water Supply: Public system -hrinunit P��Con y,system E] .Private E] Depth to Water Table ........ ft. iN'd-t Character of soil.to-a epth of 3 feet: Sand E] Gravel -Sandy Loam E] Clay Loam j?'Clay E] Adobe 0 Hardpan ❑ Previous Appkdation, Mede: (Ii yes,d ate No E] New Construction: Yes ❑ No FHA/VA. Yes [3 No El TYPE OF INSTALLATION AND SPECIFICATIONS:- (No septic tank or cesspool permitted if-public sewer is a�v;ilable`within 200 feet.) 7' eptic. T k- Distance from nearest wellA V?�7�istance from foundation._e.". o ------7 ............. No.. of compartments----------!?�-----------Size--------?_,K--- -------Liquid clepth---1 7, to !�e. -----------Capacity.. Disposal 1=field: Distance from nearest well------------------Distance from foundation._,�O.V------------Distance to nearest lot line......f... Number of lines A_;'�_ ----- of eachof trench-------- -------------- 'Type of filter material-------------------------Depth of filter.material-------_---------------(otallerigth_t-------------------------------------- Seepaq.e,Pit- 'Distance to nearest well----------------------Distance from foynclaflon...................:Distance to nearest lot line- Number of pits---- _-_/----------Lining Diameter----:i........-7, /-/. .....Depth--------%4------------------- Cesspool: bistance from nearest well.... ....Dista=ce from foundation----------------.--.Lining material....--........-_....._._...._...._._. El Size: Diameter-------- ------ -Depf h........................................... ----------.Li uid Capacity............................gals. Privy: Distance from nearest well--------_:i-------------------- IV_ . Distance from nearest building------------------------------------------- -- ----------------- Distanceto nearest lot:line------------------------------------------------------------------I---------------repairing ( ------------------------------------------------------ Remodeling and/arsclascri6e):---- ....... ------------------------------------------------------.... ..----- ---- ----- ------------- ---- 1,;---------- ................ ;�------- --------- ----------- ------------- -------- .... .............. r--- -------- --- :-.7c...... ................ ----------------------------- ------- --- I hereby certify that I havepreparedthis application and that the"work will be\ done in accordance with'San Joaquin County ordinances, State laws, and rules and re. lotions of the San Joaquin 1_6cal Health District. (Signed)., ------------------------------------------------------------------------(Owner and/or Contractor) By:---------------------------------...............r------------ ——-------I---------------------------(Title)----------------------------J................. ----------------- --------------- - (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 e APPLICATION ACCEPTED ------------------------------------------------ DATE-.-'* ----------'. . REVIEWED -BY-------------------......... -----------------------------------------------------------------------------------........ DATE-----_-------_-- f------------------: -- --- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE.............. ----------- -;/------------------------------------------- ........... Alterations and/or recommendations: -: -.V -- -, ------- .......... ---------------------------------------- ------- ------------------- ----- -------------------------------------------- - _-----_---._...--_.......-------------•-••-----•------------.- - ------------------------- ------- ............................................................................. ---------------------------------------------------------------------------------------------------------------------------;--------------- ------------------------------------ -------- -------------------- -----:--------------------------------------------- ......-----------------------------------------------------------:---------------------- FINAL INSPECTION BY:.... ..... ------- Date-------------------t....C.:---------I------------------------ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 West 9th Street Stockton,California Lod[,California Manteca,California Tracy,California ES 9 REVISED 5-89 21A 5-61 AILAII