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FOR OFFICE L,,SE: f ---------------t------�------------------- ------- `. y --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. „ .... i -----------------------=--- ---------------------------- (Complete in Duplicate) ----------------- This-Permit Expires 1 Year From Date Issued Date Issued 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 Ordinance No. 549. JOB ADDRESS AND LOCATION--------j �._r �� ------------ Owner's -•-•-••---Owner's Name---.__` /,C7 == 7G, /� i Phone. �3� Address------• � Contractor's Name •----- -------- --•--------------------------••------------------------------•---•---------------- Phone-----...----...-------............. Installation will serve: Residence [ Apartment House E] Commercial ❑ Trailer Court [IMotel Q •Other ❑ Number of living units::__/___ Number of bedrooms __ _ Number of baths ___/___ Lot size -___--__t-5_�:__. __�_ J __________________ Water Supply: Public system N Community system ❑ Private ❑ Depth to Water Table ._,----- 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_________..__.___.) No New Construction: Yes No ❑ PHA/VX: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__A_57-0____Distance from foundation--------/._9-----Material___4'Ezr-,s'=s2�_O_�?_____•-_ No. of compartments_____..__ ___Size_..-_______ _©.-__.___Li Liquid de th______________________ Capacity a s 9 P. -- -------`F-C) -- r Disposal Field: Distance from nearest well--A;-7t�__.__Distance from foundation______.(.a__ "_ Distance to nearest lot linef_ ....... ,Number of lines------•s--------------------- Length of each line_ rj _t Cy_ � Width of french__.:aZ__ E_ Type �.-- epth of filter.mafierial___�_r3`�_�J_--.-.Total' length----- -0--�__________________ T e of filter materia _ r, See a � Dist,Number of pits to rest _f _ _Lining ---Distance f ror -f S nldafi n= µ-------- -- istanc to f es of lin .________ "1 ---- ------------ Dia r ' == �C.; �'� �. Dept Cesspool: r ,Distance from nearest well--------.--------Distance from foundation---_----------------Lining material__.__:,__.__----________-._-_________- ❑ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity--r-•---• -------------------- gals. I , Privy: Distance _ _ --. -- _ _. from nearest well______________ ___.______ __ -- ____ __ _.._Distance from nearest building__-_-- ____________`;_ ❑ Distance tonearest,lot line-- - -- .,_ . , -- --- - ------------------------------------------------------------------------------ •----------------------•---------- ---- - Remodeling and/or re firing.(descr.ibe):___ '`___m': - - - ----•-------------------------------•------------------•-- --•--------•-•-----•--------------------------••---------------------- I hereby certify that I have prepared this-application end +hat`fhe work will be..done in accordance with San Joaquin County rues ordinanc State laws, and les and egulations of the San Joaquin Local Heialth_District. -� l� ' �� ----------------------- ---------------------------->-------------------------------------(Owner r .W------------------------------•-- s f ---------{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 APPLICATION ACCEPTED BY-4__ -,.C,, � -e-----%DATE------ REVIEWED ____REVIEWED BY - = ----------------- TE----------------•---•--------------------------------=---- BUILDING PERMIT ISSUED Alterations and/or recommendation ----------------- --------- ------ .:.--- -------- -------- D T�a------------------••---------- -------------- ------------- V------- _ -------- - - ••---•-------------------------- --------------------------------------------------- ! -----•---- ------------------------ ---------- ----------------- - .. •--•-•--------------- ------------------------------------------------- -------------------------------------- ------------------------- V- -------------------------------- - --------- ------ ------ --,--------------- - - FINAL INSPECTION BY:---------------------------------- ------------------ `'`== £` pate SAN JOAQUIN LOCAL HEALTH�DISTRICT `� ;�� ~ '• 130 South American Street 300 West Oak Slydet# 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 NEVISCC 0.59 r.P.00.ZM 6-60 r,:r