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r%-jr, vrnt,c uZ)t: 9 --------------------------------------------------------- --------------------------------- APPLICATION FOR SANITATION PERMIT permit No. ..!..J S �_ ------ (Complete in Duplicate) -- --------- --- This Permit Expires f 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 LO ATION_ _"--""_"._,l", �J"f " ............................. r--- ------------------- Owner's Name----------- �� _ --- ' -- ,P�, •.z= Phone---------------- �,c= , = -------------------------------- Address - ••,-.. ` r cA `� -------------••--------------••-•---------------------------••-----------•---------•------------•-••---_...._ Contractor's Name_------_ Phone_-- - - i Installation will serve: Residence Apartment House E] 52ommercial El Trailer Court E] Motel [:I Other ❑ Number of living units: _ _. Number of bedrooms .1--- Number of baths -_/_.Lot size ---------------------""".__-"""_-, ---------"--------------"- ` Water Supply: Public systemICommunistem ❑ PrIv atysy te ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoba)5 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No K FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' ` t (No septic tank or cesspool permitted if public sewer is available within,200 feet.) ^ Septic Tank: Distance from nearest well- "_Distance {rom foundation--_"-" "."-".Material_"" L'c c- - --- No: of compartments _ CC------------ --- � .. -. ... quidepth----------- Ca acitY � Disposal Field: Distance from nearest well-nP---_--Distance from foundation-_...-"h_-------Distance to nearest lot line._,,�__ Number of lines-:--_--_--_I-"""_---------------Length of each line----------4-C""T._----.Width of trench.""__.z;2_� �______,_"" Type of filter materials - :."�_�_-Depth of filter material___-"/9:_-_-""--_Total length.,...."- --------------------- _------••------- \ r ' Seepage Pit: Distance to nearest well" 1ry+��----Distance from foundation_---_1.10---------Distance to nearest lot [X' Number of pits----------`---------Lining material - . " •.-a6i ze: Dia meter----..-,353--- ---.Depth----- -•�'�_�.---- � Cesspool: Distance from nearest well----------------- _ Distance from foundation.-___,_--_:._-----.Lining material--._----.-----------/ - ----------- ❑. Size: Diameter •-------------------------------- Depth ------------------------Liquid Capacity------------------- -------.gals. Privy: Distance from nearest well---------_------- -----" ---._.__Distance from nearest building El Distance to'nearest lot line--.""_______ --_----_ - Y. _ . t Remodeling'and/or repairing,(describe):-----_----------------------------- ----------------------- l --------------------------- t ------------------------------------•---------------- ---------------------11------ ------------ --•--------- --- -- ------ -- - -------------- ----- a- 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,t and rules and regulations of the San Joaquin Local Health.District. (Signedr—' -- ----- ---. ��- ----------------------------' -- - ---- --------------- ------------ - --- ---- {Owner and/or Contractor) By:--------n- ------------------=---------••------ - --------• -------------- ---------------------------------------------- •----(Title)----------------- ----------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - —-� ---- ------�� --)----------•------------- - DATE---- REVIEWED BY".. - ----- •------------- DATE f -------- BUILDING PERMIT ISSUED -- ------------------------------_-------- -------------- •--------------- DATE.-- Alterations and/or recommendations:/____r$`.-_ _ - '= f -/fes ...... --- �" .�- ------ . ------------------ -------------------------- - ---•- ------------------ --•--------------------------------� --- " ----- ------------------------------------ -------------------- ------------------------- ---------------- -------__------ I ---------------------------------------------- -------------------------------------------•-- FINAL INSPECTION BY------------------r Date------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street d 205 West 9th Street Stockton,California lodir California Manteca,California Tracy,California EG-9 REVISED H•59 C.P,C O.SM 6'6O