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+ FOR OFFICE USE: --- --------- ------------------ J `7 : _-------- APPLICATION FOR SANITATION PERMIT Permit No. - - ------------- (Complete in Duplicate) Date Issued ---�-�j ----- -------------------------------------- •• This Permit Expires 1 Year From 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 Ordinn ce to. 549. ` �.� �/r- s Pr - ------------ -----------,IOB DDRESS AND LOCATION.__. -- ------ -- . Owner's Name ------------- Phone.---------•---------•---------••-- Address Ytll. y�, ----- �' Phone... Contractor`s Name.------ ---- Installation will serve: Residence Apartment House ElCommercial E] Trailey Court ❑ Motel C] Other [I J--- Number of living units: _--_ Number of bedrooms -.;� Number of bath __! s rt.size ------- -- __ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ' � • Character of soil to a depth of.3•feet- Sand ❑ Gravel ❑ Sandy Loam 0,. Clay ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date____________________) No'b!� New Construction: Yes 1P No ❑ FHA/VA: Yes E] N0 [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 i Septic Tank: Distance from nearest well---s5,_._-_Distant from fours ation___�_ ____..___..Mat n I----_ -- ---- a-..� __:_ __ _ - � .cam' ._ Li uid de}h Capacity------ -------------- No. of compartments_----:_`Y- - ---Size_- -- -- - ! q p• jr / --- _- ----..Distance to nearest lot Ii Disposal Field: Distance from nearest wei3__.?.V_.___Distance from foundation____ Length of each line.h Width of trench_.__ -----------------_ j� Number of iines_ _-------- -------- 9 71 -_Depth of filter material-____f --_--------Total length------;� ',e�------------------- Type of filter material j-'�' - Seepage Pit: Distance to nearest well----------------------Distance from foundation-------..............Distance to nearest lot line_---_-_----_.---_ ❑ ---- Number of pits- --------------- ----Lining mater'sal---------; -----------Size: Diameter-----------------------Depth--------- ------- Cesspool: Distance from nearest well---___-_-_-----_Distance from foundation--=-----------------Lining material------------------------------------- ❑ Size: Diameter---------- ---- ----------- ------ Depth-_- �------------�-:,�ti--._---------------------"--------�-LiquidCapacity.-=----------------- --- _ Privy: Distance from nearest well------------------------------- ------ Distance from nearest 1:70ding-------------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------- -----•------•._-------------------•-----------••------------------- - 1 ' --s� Remodeling and/or repairing (describe________ - _ ---------------- --------------------------- - ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------ -------- -------------I--------------------- ------------ - - - - - --------------------------------------------------- ---------------- ------ -------------- --•- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfaf laws, and rulds and "Kions 94 the San JoaAui ocal Health District. towner and/or Contractor) Si ne ---------------------- ------ -------------------------- ----- - --------------- Title - - -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r - FOR DEPARTMENT USE ONLY `- APPLICATIONACCEPTED BY--------------- -------------------------------------- - - -- -•---------------- DATE--------------------- -------- -------------------------- REVIEWED BY - --------------------- DATE-------/6--'" --_- -- ` -------------- BUILDING PERMIT ISSUED---------------------------------------- DATE - Alterations and/or recommendations ------ •----•------------•-------------------"-•--- -------- ------------------------------------- ------------------------------ FINAL INSPECTION BY-------------- DateC �� f ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California monteca,California Tracy,California EB9 gr_vl6Eo 9.99 F.P.Co.2.6.60