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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - ------------ --------- ------------ --------------- (Complete in Duplicate) F ------ 'This Permif Expires 1_Year from Date Issued Date Issue d..... .....:: .�_ Application is hereby rnade 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 ATJON_,1+___A---------------------- ----'-------F-r _(_K---- -----~--- ------------ 00V<� 'Owner's Name `.-•• • "-••------. ------------------------------------------------------------------------------------ Phone-----•-•---• "•----._...---------- r� f Addressk'�°►nc ��" - -- --- ---� Contractor's Name--.---- --------------------------------------------------- Phone.------.-----•----•-"-"----•---' �f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other :R -rt"d l'P(, Number of living units: --- Number of bedrooms .-I____ Number of baths ___ Lot size ------ __________________ Water Supply: Public system ❑ Commuriity system ❑ Private JK Depth to Water Table _F..._ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 1. Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No DR New Construction: Yes ❑ No ❑. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellUf1I1-Distance. from f�ae l fn1 -q_`__.Matenpl--_----- ------------r- ------------ No. of compartmen ---------- _ _Liquid depth------- d • r Disposal Field: Distance from nearest well_P.N10, Distance from fa3ien.��lLlh�___Distance to nearest lot lineA.__-�_-______- Number of"lines'_.________________-______ Length of each line________6A---___________Width of trench___________UZ-._ ___y__.____._ Type of filter material-. __ ______�_ __Depth of filter material_.--1�--------------Total length____._....--_�___+__-_-_____________ Seepage Pit: Distance to nearest.well______ _______________Distance from foundation-----------.........Distance to nearest lot line------_......... .= ❑ Number of pits_->-------------------Lining material------------------------Size. Diameter.-----------------------Depth-.---------------------------,_.. Cesspool: Distance from nearest well----------------- from .foundation--------------------Lining material______________________________________ Sizer Diameter--------- ----- gals. Dept _ _Liquid Capacity- --------------------•--• 9 , Privy: 1Distance from nearest well-_________________ ______________________________Distance from nearest building------------------------------------------- ❑ ry _ ' ::Distance to �neareat°lot line------------- -- -- ------------------------------....-----------------•----•-----------------•----------------- �-- ---- ------ Remodeling and/or repairing (describe)=- ----------------------------------------------------•------------------------------------- ---------------------------- -•-----------•............ ---•----------------------------------------------------------------------------------------------•---------------------------•--------------------- - I F tLk------------------------------------- , _ _...,,.. .,_._ - , •. 6 � y�,� I'hereby certify that I have prepared this application and that the work will be done inaccordancewith San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ___�i s-� J '�_`----�'- r----- (Owner and/or Contractor) (Signed)------- (Plot Ian, showing size of lot, location of system in relation to wells,-- -------------�------{TitleJ.:._______.__._.___-_...________._._ p g y buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------=-------------- ------------------------ _---�_I _. DATE----------- --------------------- REVIEWEDBY = - ---------------------------- --------------------------------------------------------=-- DATE-------- -------------_--; .: BUILDING PERMIT'ISSUED------------------ - - - - ---------------=-----------------------------------------r---------- DATE--------------------------- Alterations d/or r commendations•__-_._.:_ _ . --------------------------" --------------------------------------------= ' ..:__. - C---------- -. ..--- -- ------ ----------- -�.. ---------------------------------------------- .... ""----____.. .- _�- ----- ------------ � : - "Tf r r '" --- - ------ -- -------"" --------- `rr ��. ; �_�. _..--•----- J - Date----- t...� .... FINAL INSPECTION BY: T - D -•--.. SAN JOAQUIN LOCAL HEALTH DISTRICT i 4 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street �s Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVIBEO 8-59 F.P.CCI.7,M b-60