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FOR OFFJCE U E: APPLICATION` FOR`SANITATION PERMIT Permit No. -,��-� - ---�------- ------------------------------- ... �`_ . --------------•------------------------------------------ (Complete in Duplicate) Date Issued 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 Ordinance No. 549. JOB ADDRESS AN LO TI � D7__� -- •----- ---- . Phone" �"/ Owner's Name-------- ---- ------ " ` `3 l� ` Address------------__------------- ------ - ----- ------- -------------_ r � Contractor's Name--- ........... .. --R---- ----T4----` '��`'�---------------••-------------•---•------•------ Phone - .... _:..�6 P._.. Installation will serve: Residence [Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ _ Other ❑ Number of living units: _/__ Number of bedrooms __rte_ Number of'baths /__ Lot size ------eb __4 .. -----------------_----------- Water Supply: Public system ❑ Community system ❑ Private E'-'Depth to Water Table%T- ft. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -lardpan ❑ Previous Application Made: {lf yes,date-----------_--------_l No ❑ New Construction: Yes ❑ No 2j--1FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)..,: k: Distance from nearest well________________Distance from foundation--------------------Material-----------------._--:--._______-___..__________- ❑ No. of compartments--------••---------��Size------•-----------------•------Liquid depth------------------------- apa i y------ Disposal Field: Distance from nearest well_ 4'._._-_-_Distance from foundedI}}��on__ ___......Distance to nearest lot lie __. Number of lines_______f____ ___. Length of each line.__s.�.,Q_-______________Width of trench___rZy--- of filter material__ .1 _ _QC_��__Depth of filter material---- Seepage aterial_:_ Total length_________________ ----------------- Type Seepage Distance to nearest well_/Q_O.........Distance m foundation__/ "....Distance to nearest lot line__+S__d__f_.. 0' Number of pits------/------------Lining material-- -- -_pCl�'_-Size: Diameter---,313-----------Depth-----2ti - ---------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------.-----Lining material_-------..-------- ............. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.----------- ----------_--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------...______- ❑ Distance to nearest lot line---------------------------------------- r'----------------------------••------------------------------ ------ Remodeling and/or repairing,(describe):---------------------- ...--------------_--------= -----------------------------------------_-_----------------------------...... -----•-------------------•-• ------------------ t ------------------------- ----------- 1------------------.------------------------------------------------------------------------------------------------•-----•-•----------------••-----------------. --- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e a s, and rule and regu ons of the San Joaquin Local Health District. (Signed).__ 1i t wrier and/or Contractor] p / Z� By:------------------------------------------ {Title) ---- ------------ p------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to s, buildings, etc., can-be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------ DATE---------rte �7--6, -------- REVIEWEDBY------------------------------ ---------------------------------------------------------------------------------------•-•- DATE---------------------- --- BUILDINGPERMIT ISSUED----- ------------------------- - --- --------------------------- DATE------------------y-------- - ---------- ------------ men PioAlterations an or r -----------------------•---•--------------------- -----•--------- •--------------------------- •-• -- ------------------ •---•---------••---•--------------------• --•---- -------------- --•--- -------------------------------------------------------------------•------ - ----- ---------------•----------------------••-----------------------.-------------------------•------------•-------------------------------- FINALINSPECTION BY------------------_-•------------------------------------------ Date---------------•--------•-------•--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ? 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California :�4` Manteca,California Tracy,California ES-9 REVISED 0.69 F.P.00.8M 6.60