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FOR OFFICE USE: - ----------------- ------------------- -- -------------- - APPLICATION FOR SANITATION PERMIT Permit No. ...>! __ : ------------------------- ---------------------------- (Complete in Duplicate) ---- ---------------------------------------- Date Issued ---- " This Permit_Expires 1 Year From Date Issued ---------------(c� 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 Ordinan a No. 549. JOB ADDRESS ROCATION .. �1 Z?._.Owner's Name--- _!{� - ---- Phone------------------- •••-Address-----•--------- �----------- --...--•--------------------------------------------------------------------------------------------------- Contractor's Name - --- --•--------------_.._'Phone.-----�---------------- ---•-•--- Installation will serve: Residence ED,"'Apartment House ❑ Commercial .�] Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _/___ Number of bedrooms _rte'._ Number of baths ---- Lot size ---------------------.--___-.-- Wafer Supply: Public system �mmunity system ❑ Priv�te,[]r Qepth to Water Table. 1Wf t " Character of soil to a depth of 3 feet: E Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ `New Construction: Yes ❑ .No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspo01 permitted i# public sewer is available within 200 feet.)) Septic T k: No} " Trest well *- efoundation--- �- - - tY uidpaci �of compartme ,�. Disposal Field: Distance from nearest well:?_..:,:,----------Distance from foundation.__ _r.____.DiStance"to nearest lot fine-4........... Number of lines----- __ _,_ ___-__JLength of each line_._�� <_____`____. ___.Width of trench... ._�..................... Type of filter materialz_ . __Depth of"filter mater ial_ ___+____Total length_______ �__________________________ Seepage Distance to nearest well_"_�-______.___ •____Distance fr m fo ndation____ �____....Qistance to nearest lot line.��..._�... r . .-. -- Number of pits------l---------__:Linmg material.. - __-___.Size"-Diamete --------Depth__..'1,__,.r_!_______________ Cesspool: Distance from nearest well.......i:-------'Distance from foundation-------------'_:__-.Lining material--_----_-___-_-__---_-_----___-----_. ❑ Size:.Diameter -- -------- Depth------------------------------------------ -- Liquid Capacity gals. r ., Privy: Distance from nearest well______________________-----.-__--_--------------Distance from nearest building-----------------------..- _--_--_--_. .. R . _ Distanceto nearest lot line.-•----------------------•--•--------------------•------ ---------------------------•------- ----- ----------- ------ -------------- r � Remodeling and/or repairing fdescribe):----- � ----------- :{ --------- = - ------ - •---------------------------------------- C F ----------------------------------------------------------------------9 ----'----=----------- -------------------------- I hereby certify that I have prepared thi'saapplicafion and that the work will be done in accoMance with'San Joaquin County ordinances, State laws, and rules and eguI tions of the San Joaquin Local Health District. t,- (Signed) -------------{Owner and/or Contractor) --- --_- s ------- Title l<By:----------------------------------------------------------------------- - - --------------------------I ) -------------- --------------------- (Plot ------- --------- (Plot plan, showing size of lot, location of system ' lation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _ _-�._._ ` --�___. ._ ___ __•......... ....... ----------------- DATE------. T -6/--------------------- REVIEWEDBY-------------------------------- -- ----------------------------------------------------_---------------------- DATE---------------------------------------- "- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or -.-`�e--. recommendations:---i------ ------------------- -------------------------- ------------ ---- ------ �'- �••!y-'` - ------------------------ e/ � -_� K '4��s-_ __{ ---t_". �------------------. __________ -------------_-------. -__ -----.----._ ------------------------------ ----------------------------------------- FINAL INSPECTION BY:_.. ___c __ `�___ -lC/ !�r-Late--------`.�- �-�_^ SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 3'WWest Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California A ,Lodi,California 3 �J Manteca,California Tracy,California E6-9 9EVSED e•59 r.P.00.2M 6-60 i