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FOR OFFICE USE: ------------------ --- ---------------- , 3 2 o 3 ___________________________________ _____________ APPLICATION FOR SANITATION PERMIT Permit No. ._..-----_-__-_-__---__- (Complete in Duplicate) V G----------------------------------------------------- --- This Permit Ex ires 1 Year From Date Issued Date Issued ______ ______/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here' de be�rj , R This application is made in compliance with County Ordinance o. 549. E JOB ADDRESS AND LOCATION_-� -_� �- ---- -------- 3____ - - - '------ Owner's Name------------------ ;A..t_ '- Phone----••---------------- Address.............t___-_------- F j Contractor's Name... -0 .... ..... __ Phone.. ------. -•---- a - ----------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rt , Number of,living units: _____ Number of bedrooms___. Number of baths .,l____ Lot size ........................................... � � � t Water Supply: Public system ❑ Community syst ❑ Private Depth to Water Table .____--. ft, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE-OF"INSTALLATION' ANW'SPECIFICATIONS: (No septic tank or cesspool permitted if public severer is available within 200 feet) Septic Tank: Distance from nearest well--50.l � 1� '�'M "�G Distance from,fou anon__ _ _______________ at rial---_.__ -___.________________-----_-... No. of compartments______2---------------Size-/V� � .....Li uid de t .________-Capacity...— 0__ Disposal Field: Distance from nearest ell.. ....._ 'stance from foundation,AQ '>`!'"`Distance to nearest lot ling.._�_'��•+n Number of lines_________ Length of each line______91______________..WidW of trench.__ ' ' Type of filter material_. __ __ __Depth of filter material____,/_-_________Total length________ - --__--____________-__ Seepage Pit: Distance to nearest well____ _____________Distance from foundation_____________.------Distance to nearest lot line_____._________-_ ❑ Number of pits_-------------------Lining material,------------------_-Size: Diameter--------------I--------Depth---:---.-------------------- Cesspool: -- ----------- ----- Cesspool: Distance from nearest well_________.______Distance from foundation__ _________________Lining I material------- ----------------------- Size: ___-__-___-__________Size: Diameter--------------------------------------Depth---------------------------------------------------- Liquid Capacity-----R---t---.............. gals. i Privy: Distance from nearest well._..________________-__-________.____________Distance from neares# building___________ _____________________________ ❑ Distance to nearest lot line-----------------------------------------------------------------_--------------••-- Remodeling and/or repairing (describe ---------------------------------------------- ----------•-•------------------------------ ".- r . --------------------------•---•------------------------------•------•----•----•- t t � 11- ---------------------------------------------------------------------------- -.----- ,� .� t 1* 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r �l� (Si ned �,/ 9 ! 4 —IJ—_—f---- (Owner and/or Contractarl ! — t_ - .. _ •--- ----ITitle):---�" { ,(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F( R"EPARTMENT USE ONLY ( II APPLICATION ACCEPTED __. _�� -- ---- - --- - - REVIEWEDBY_-----------------------------------------------------------------------------------------------------...------A---- _--- DATE-------------------------------- BUILDING PERMIT ISSUED----------------------------------------_----------------------------------------------}--------- DATE----------=: I - ---------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------- -•---------•----•------•---------------•---------___-------•---•------- --------------=------------------------•----------•------------- -----------•- --------------------------------------------•---•-------.-------..---•----•--------------•-----------•---- --------._...----•--- --------------------------------------------------------------- `-------- - ----------_ - ------------------------------------•-••----••---------------------•--------•-------------------------------------- ------------------------- --------------------- --- ----- - ------ -9---- ------- _ - ...--�---;-----------------------------------------•----•---- - - -• ------------------------------------------------ ------- ----I---- -- ---------- FINAL INSPEC - ---- Date------..O � �------ -------- f JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street- Y'w 124 Sycamore Street 205 West 9th Street Stockton,California i Lodi,California s� Manteca,California Tracy,California EP-9 FEEVI9E0 9-59 F.P.CO.2M 6.60