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FOR OFFICE USE: f -----�°3CfJ'i �! APPLICATION FOR SANITATION .PERMIT Permit No. . -------------- ----------------- ---------------------- i - -------------------------------------------------------- (Complete in Duplicate) �I I -------------------------------------------- ____________ _` „This Permit Expires 1 Year From Date Issued Date Issued _._.._� ___G_.f. Application is hereby made to the San Joaquin•Local rHealth District'for a permit to construct and in4all the work herein described. This application is made in compliance with County Or in ce No. 549. i JOB +ADDRESS AND SOC ION... . _.� ------------------------------------------•-•--•---•----------•-------------------------------.------••---•------------ Owner's Na-Me.___. __ - one_..__. ;. Phone ------------------------------ Addressr --_-----• -•---=-=-------------------- -- - -----------• -—•--•------•--------- .... N r --------------------- -------- ----.......--- ----••......----._.__----------•-- Contractor s ame--------------- _- _ --------------------------/_.1 :---- °.�_�•� ~ Phone j Installation will serve: Residence Apartment House ❑ . Commercial [] Traile Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms _ _ Number of baths Lot size __/i _ _lam _____________________________ r Water Supply: Public'System Community.system El-Private E] Depth to Water Table 7(�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-------------+------,l No New Construction: Yes ❑ No R3-'-_F_HA/VA: Yes ❑ No 9— TYPE ---•TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)L Septjc T nk b Distance from nearest well------------_----Distance,from foundation____________._-__-_.Material_________._.___.__.______.--__-______._:_-------- GNo. of compartmerits--------------------- ----Size--------- ------.........Liquid depth r{ Capacity._:._ Dis oral Field: `k Distance from nearest-well__l_...n :"--".:Distance from foundati n.....'4 ---------Distance to nearest low line_�_��___-_ r Number of lines______.______- ' Length of each Cline____�,0�______________Width of trench.-z s-., Type of filter material � i___Depth of filter material-;� G�---__-Total length-----��--------------_____________ Seepage Pit: Distancerto nearest well-----—__-_____'Distance fr foundation___.A?_.___.Distance to nearest lot line.__-___-- k Number of pits-------/-----------Lining /_SDia iameter__. ___r�" material-•--- - - -- .� � -------.Depth----_��.40�7----............ \ Cess pool: Distance from nearest well--------------------Distance from foundation-----------------___Lining material-------------------------............. ❑ Size: Diameter---------------------------------=----Depth---•---------------------------------;----------Liquid Capacity--------------.------------gals. Privy: Distance from nearest well__--- ------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot liner -----`----------- - -- - ----- --------------- ------------------------------------------------------------------- Remodeling ----------•-------------- ------------------------Remodeling and/or repairing (describe)--------------------- _ ____________________________________�_:____ -------------------- _-.__-________ _______________-__.__-________-____-_-_.________-___ ___________________________________________________________________ ______ --- --------------------------------------------------------------------------------------------_-----------------------------------------------------_------------------------------------.--------------------------------------- I _-_________________.__--- _I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, arules and regulations of the San Joaquin Local Health District. L s k ( - 'ter Contractor) ---------(Signed)By:---------------------------- -- •---------------------Title) (Plot plan, showing size of lot, location of s s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 09 DATE__ . �. APPLICATION ACCEPTED BY--- Cp-- - -- -- --------- ��. REVIEWED BY--------------------------------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- -------------- DATE----------------------------- ------------------------------ Alterations and/or recommendations:----_------------------------------------- --------------------------------------------------::"`- ------------------------- ------------------ ----------------- - - ----------------------------------------__---•-•----•----- f �.., /Jj /J* /4 --r-- --- .! _—!!rte!-2✓ _-.._ .�-�G --.GrIS. =_ ---- ---- -• =t-'---•-,�--------- P---••f---- •-------••-- .�_� F FINAL INSPECTION BY:_. ,_ �a. .. � ----- Date-----------``---- —-•-1"------ ------------------------------------ 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 E6.9 REV16r0 8-69 F.F.CO.SM 6.60