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FOR OFFICE USE: -- -" Y - -------------------------------------------------------- .___.._._______________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. Z-��..,2_5 ------------------------ -------------------------------- (Complete in Duplicatel 6 (�� This Permit Expires i Year From Date Issued Date Issued _. 17_ 01- Application is hereby made to the San Joa uin Local Health District fora 2_02- l`�^� Joaquin permit to construct and install t work herd seri This application is made in couliance, with County Ordinance_No ,549., JOB ADDRESS Al _.p ------------------------------ ---------- ------- Owner's Name ----------------�L.--±........ . Phone............ -=-•--- Addressi_. --------------- -----•------------- -------------•----------------------------------...---------------------------....-----------•-------------....... Contractor's Name. `- ---- •------------- Phone------------------------------ Installation will serve: Residence A. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j-__Number of bedrooms-.1—Number of baths ----Kot size -•--••------f-�---•- ----- --- ------- Water Supply: Public system ❑ Community system ❑ Private 11�11 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No', New Construction: Yot No ❑ FHA/VA: Yes ❑ NON TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Not of com artments ance from nearest I L1Q'___Distan 1a from fo�Vnd ion____ .Q_.______.Mater L ... ___ __�_}_____ p Size_ p r _�iquid depth- ------------Capacity/-�3 - Dis� � � p al Field: Distance from near well-2-0. Distance from found�tion....l�____ Distance to nearest to line._��___..._. Number of lines-__ ___Length of each Iine____�r___--- Q_' +Vidth of trench-" ___-•______________________ 1.77 Type of filter materia0__)___?"}1#"+f.Y-Depth of filter material_______ _ Total length_____,2__44 Seepage Pit: Distance to nearestwell-------___------------Distance from foundation--------------------Distance to nearest lot line__.__._____.___._ ❑ Number of pits----:-----------------Lining mater ial-----------------------Size: Diameter----------------------- Depth----------------------- Cesspool: ._.-______.___._ __ CessPool: Da nearest wellDistance from foundationLining tel --_---_-_-_-_-_-_•_- _ ❑ zeDameter. ----------"-""---Depth----------------------------------------------------Liquid CaPcit ___________.. .-.-------, -gals. Privy: Distance from nearest well---------------------------------- ------------_-Distance from nearest building------- _ .---_---._ ❑ Distance to nearest lot line--------------------------------------------------------------- ---•-----•---------•----••-------------------------------------- f Remodeling and/or repairing (describe):__.__ __ - -._ _ ; --------------------------------- ---------•------ -------------------•-----------------•-------------•--•---------------------- ---------------------------------- 1 -----------------------------------------------•--- 3 I hereby certify that 1 have prepared this application and +lief 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)--------------------------•--------------------------------------------------------- -------------------------------------------"------------------•--- -----.(Owner and/or Contractor) i By=-------------------------------------------------------------•-----------------------------------------------------------.---------(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------------------------- -- --- ---------------------------------------------------------- DATE--------- - -- REVIEWEDBY--------------------------------------------- - ---------------------------------------------------------- DATE_....... "r-, BUILDING PERMIT ISSUED------------------------------------------------------- DATE.------------------------ Alterations and/or recommendations:--------------------------------- .-.____.._____________.__________ .. ----- -- ----- -------•--------------------------------------------------------- ------- -------------------------------------------------------- ......._ ---- ---------------------•-•---•----------------------- ---------------------------•---------------------------------------•--------------------------------•••-----------------------•-- -------------------------------- ----------•-- --------------------- ---------------------------------------------------- ------------ •----------------------------------------------------------------------------------------•- ------------------ FINAL INSPECTION BY: ---- Date _ -----------------------------------...... 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 ES-9 REVIGEO 8.59 F.P,00.2M 6.60