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FOROFFICE SE: �.-- f f-- -------- -/d{--------v3_ '! s APPLICATION FOR_SANITATION PERMIT `,,Permit No. .... _�7.� ------------------ --------------------------------- (Complete in Duplicate) ``: Date Issued -------�?/__�rp� ----------------- ------ ---------- ------------�---. } "This�Permit Expires 1'Year`From Date Issued - Application is hereby made to the'San Joaquin Local, Health District fore permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. t { r .. # JOB ADDRESS ANDCATION- - -_:- Owner's Na �_ -------------------------- Phone ? Address !-.. ------------ Installactor's Name - ----------= --- �1�= �F _ _ _ __. Phone__ ...... .... Contra _ _ _35� �i tion will serve: Residence ❑ Apartment House ❑ Commercial ❑ -Traile Q u t ❑ . Motel ❑ Other 21• Number of living units: ----...--.Number.Number of bedrooms ._-____- Number of baths ___ Lo size ___. Ir _ ______. _ It . Water Supply: Public system Comrriunify system ❑ Private ❑ Depth to Water Table�` ft. Character of soil to a depth'of 3 f et: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarri Clay Adobe Y ❑ Y ❑ e Hardpan ❑ Previous Application Made: (If yes,dcite-i__________________) No ❑ '"New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-AND SPECIFICATIONS: t s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'ti T Distance frorn nearest well-----------------Distance. from foundation-________-_'_.___.Material.________._____.__-_.______...____. - No' of compartments = - ---------Size----------------------- -------Li-.-Liquid de .th-------•--r------------•--Ca Capacity I q A P tY-------- ---------------- 'so -------------- Disposal Fi d: Distance from nearest well --Distance from foundation---f�_--.-___Distance to nearest lot line___- Number of lines ___- /____----. ----Length of each line___________,1�-I-- _.Width of trench-------- ~---1.-------- Type of filter material_ ;Depth of filter material_:_-./_-g______._Total length___-________-_____ ____.____ Seepa e Pit: Distance to nearest ell__ _ :_ DistaKe r(!Im undatio__ I �J�° ,,.Q_.__.___.Distar< a to nearest lot line-_____A_.--____ 1 Number of pits__---_ --------------Lining rriaterial_.. - - - ( ' 5izei'Diameter $--- Depth 6;2--4 I-------------- "V C/6" t i C sspool: Distance from nearest waif________ ____Distance from foundation -------------------Lining material--------------------------- ---------- ; ❑ _ Size: Diameter----yt- = -----•-- --------- ---------Depth_-.------------------------ `.Liquid Capacity -.-gals. * Privy:;. Distance from nearest well._______________ ._______Distance from nearest building w` "'Distance' to nearest lot line'._--___.___ ❑, ---------------------------- Remodeling and/or repairing (describe):--------- -------------------------------------------------- •------------------ - - _ --: �„ - - --------------------------------------:7----- f -"f .. ----------=------------------ -------------------------- I hereby certify th`a+ I have prepared this ap lica+ion and tha work will be done in accordance with San Joaquin County ordinances, Stafe laws,t.and.rules and regulation the SaZJoqu- Lacal . alth D' ict. � -(Signed)- -�----- �- --- ---- = L �-- ------ - ----- -- ---- ---•------ caner and/or Contractor) - r `�'6'� Y�------ - - -- ------ - ------------------- -----"- ---=------------------------------------------------------------{Tit (plot plan, shown g size of lot, location f system in relation to wells, buildings, etc., can be'placed on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... l — ? �t --- --------------------------=-- - DATE--= --- -- ------------ REVIEWED BY-------------- ----------------------- -•---------------•------=---------------------•------------------------------------------- •------=----------- DATE-------------- BUILDING PERMIT ISSUED-____:_____--" --------- - ' - - -------------------- DATE-------•---- --------------------------------- Alterations and/or recommendationsF_____________-_________- _ _ 4 _________________________________________________ ______________________________________ ------------ -------------------------------------------------------------- ---------------•-----------------------------•-------------- f-------- ------------------------- --- ------------------------ --------------------.-------------------------------------------------------------- ----------------------------- FINAL INSPECTION BY:. � ----- --------- -------•------- Date----- - -`�----.s�,l.��--• ------- --_ ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Locil,California Manteca,California Tracy,California CS-9 REVIBEO 8.69 P.P.CO,3M 6-60