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FOROFFICE USE: — - - .� ------=-------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .................------ --------------------------------------------------- ------ (Complete in Duplicate) ` - I-" -Q I - ---- This Permit Expires 1Year 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_appllGation is made, rl_compliance.wth County Ordinano No. 549. —JOB—ADDRESS AND CATION___.1 %___ - ----=---- ------ --- _,- &Z ..-------- Owner's Name -- -----------:-:-----------•- - -------------- Phone P Address. --•-•- v.2 , - ...--- ' ----------------- --i----------------------- --•----------- Contractor's Name---- �_`�/r�'&�1.(! '..-- •----------• ---------••---------- - =•------ 'Ph one----•---•=................. Installation will serve: Residence 2�t 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motef'�.'❑- Other ❑ Number of livingunits: __ _ Number of bedrooms_ _ �-- J7 Number of baths Lot size._��-:- ��_�,,,,-•-_,--_-•--,•---. Water'Su I Public stem ppy� ucs y ❑ Community system ❑ Private V?'�epth to Water-Table4o,�P_ ft. ti Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j Clay Loam [3Clay Adobe ❑ Hardpan ❑ _Previous Application Made: (lf yes,date____________________l No New Construction: ,Yes:E] No ® PHA/VA: Yes El No �9 - TYPE OF INSTALLATION AND SPECIFICATIONS: - t - �- _ _ _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T Se tic Tank:i Distance from nearest well______ __________Distance from foundation--------------------Material ___-___________.________-_-.________-_____.__-.. 17�/4,qr No. of compartments----------------------_.__Size--------------- ----------- Liquid depth--------------------------Capacity DisposaJ Figldd:: Distance from nearest we1L--rQ 1..._.Distance from,foundation___'�0T"__..Distance to nearest lot / L g --------------Width of trench--�- P Number of lines-_______�____ ________ Len th of each line___ .�2 d Type of filter material�4t�0e__Depth of filter material_- t ___________Total length__---�W�_-------------------- M f _ ---- Seepage Pit: Distance to nearest well__,lAO---��_Distance from foy ndation____ `____-DistaFnce to nearest lot li e__-��_. -------- Number __ Number of pits-___,f_____________Lining materia l__za..4Y_C__.Size: Diameter__,R,!_-_-..........Depth_,,4oe Depth-14J-7 _________-_------- Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material-----------------.__________- 13 Size: Diameter. ----------==-=-==------.pepth �:__:----------•--------- Liquid Capacity gals. 9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building Distance to nearest lot line___________ __________.__.___ Remodeling and/or repairing (describe)_---------_________ � .� ----------------- r ------- - . { - ---------••--- ------- ----- G�i _eS.� r5n ------------------ • ---.- = liv ---- -----------•-•-------------- 1 hereby certify that I have prepar is application-and that the work will be done in accordance with San Joaquin Count� 4 f� ordinances, State laws, and rules and regulations of the':San Joaquin Local Health District. (Si nefd)=--- - 1 : - -i �_ ---•---------------------- Contractor) k----- ---- -------------- -- - By:-------------------------------------------------:_.t--------- ---•-(Title)•---�- - -- --�-- --- ----- (Plot plan, showing size of lot, location of syst to relation to wells, buildings, etc., can be placed on reverse side). " + a FORI EPARTMENT USE ONLY ' APPLICATION ACCEPTED BY-.-- ------------------------------------------------ DATE y 1 REVIEWED BY -•---- --- ----------------------------------•--------------------•----------------- DATE--------------------- I 'A BUILDING PERMIT ISSUED------• ----- ------------------------- ------ DATE.----------------- Alterations and/or recommendations------------------_----------- ------------------------------------------------------=---•------- -----------------•-----------------------------------•---------•-- -------------------------- ------------------------- ------------------------------------------------------------------------------------------• ------------------I-----------------------•--------- -----------•-------•-----------------------------------•---------------•--------------- FINAL INSPECTION BY -__-- - ------------------------------ -------------- Date--/----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sire.+ .124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California f . 'ti Manteca;California 0 _ Tracy,California E9-4 REVISED.•99 F.P.Cp,3M 6•fip •