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FOR OFFICE USE: --------------------------------------------------------- �z � -----__., --- __ _ z APPLICATION FOR SANITATION PERMIT Permit No ....... . ........ -`- --'- - -------- - ----------- (Complete in Duplicate) -------- -__--____._-. This Permit Expires 1 Year From Date Issued Date Issued .._....1.. '_. 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 OrdinanceNo.�549JOB ADDRESS AND CATION . f } Owner's Name �.. 1``f' � . Phone................ Address------------- - - - ------ ----------- -- -- .t:� Contractor's Name._._-- � � Phone______________ 01 Installation will serve: Residence 2+ Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ r 11 Number of living units: Y---- Number of bedrooms _A'_ Number of baths ___.____ Lot size -_ _ --- _ _�_____________________________________ i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _Af ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: (If yes,date________________.._) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic To k:` Distance from nearest well--------------.-_Distance from foundation_____-__-___-_____.Material____-____---_____-_-_____--_----.------------ IF -f No. of compartments-------------------- -----Size--------------------------------Liquid depth........------------------capacity---------------•------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line------------ a, / dG� Number of lines-----------------------------------Length of each,fine------------- ----------.Width of trench--------------.--------------------- \v Type of filter material-------------------------Depth of filter material-----------------------Total length__________---.-___--_____-_.-________-_ Seepage Pit: Distance to nearest wed------ from foundation__-le_ _._..Distance to nearest lot line_ �__.. \�[ p V Number of pits-_-_y_,_:__..____.Lining material-/&�r___-Size: Diameter _tom-".._..._--Depth_.��...e��_--________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 171 Size: Diameteri_*----------------------- ----------Depth---------------------------------------------------Liquid Capaci.ty--------------------- ------gals, Privy: Distance from (nearest well-------------------------------------------------Distance from nearest building--------------------------._-------____-_. [] Distance to nearest lot line •---------------------- --•------------------------------------------------------------------- 3 Remodeling and/or repairing (describe):------------ 'tom / ✓ -------------------------------------------------------•----------•-------••---------•--------------------------------------------------------------------------------------------•-------------.----•------------------------ --------- ------------------------------------------------------------------------------------------------------------------------...... --•----•-----------------• --------------•------------------------------------- ----------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, and rules and regulations of the San Joaquin Local Health District. (Signed) ------------- r t - ------------ By: ---------- (®4raerrd'/or Contractor) J Tt BY--------- ------------------------------------------- ----- ( 'tia) - (Plot plan, showing size of loft, location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT LIM ONLY `'�` ------------- `2-e--( ------- DATE---- ----� ---•- ---- APPLICATION ACCEPTED BY---- v �r REVIEWEDBY--------•------------------------------•----r---------------------------------------------------- ---------- DATE - ------------------------------ BUILDINGPERMIT ISSUED----- ----------------------------------------- --------------------- -•-------••---•--- ---------• DATE----------------------------------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------- -------•--------•------•--•----•-------------------------- = v d -� ,� - --------------------------------------------------------------- ----------------------------------------------------- ---- ... FINAL INSPECTION BY:. �-/----------------------------------------- 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 E8•9 FlEv16EC a•59 F.P.co.2M 6.60