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SANITATION PERMIT Permit No. �.7..,.�/,7__. 1 APPLICATION FOR , (Complete in Duplicate) _ Date Issued ___,/..�__(P.f�. 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 A O TION-- - ZG�_- - -- ---- - - •-� ------------------------------ -•-•-•-•------ - Owner's Name '' --------•------------------------ - ---------------------- Phone qr� � f-- [C - Address----••- � �- --- -- ------------------------------------------------------------------------------------------------•----....;_.. !, - -----.-. Phone----------------------------------- Contractor's ' Name--- ------------------ ---------------------- ---------------- •-------------- -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ G _ i Number of living units: _ Number of bedrooms ._ Number of baths __/-- Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -1laft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam Clay E] Adobe [DHardpan ❑ Previous Application Made: Yes ❑ No gr New Construction: Yes ff".No ❑ FHA/VA: Yes 5 s'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' i('. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f s " Septic Tank: Distance from nearest well_�/�---__Distance from foundation.---A9-._--._-.Material--. _ __ t , --------- ��,/ _ z Q I No. of compartments..... f _ Size_ P y s. -- -------- - �� x-�P-------Liquid de fth -- �--------- Ca acit ;.:- �_.- Disposal Field: Distance from nearest well...%rP ---.Distance from foundatian____� ___. ..Distance to nearest lot line__,4'_:__.__:__. � si Number of lines-------- ---- ---------�--J Length of each line_ ---p--f� ____Width of trench---,��-------------------- Type of filter material ___ei 6��Depth of filter material-_-f ____ Total length___._ � --_____---:-__-_-------- Seepage Pit: Distance to nearest well__&/7--------Distance from foundation_Z�iP_-----_.D• t `�e to nearest lot Ime_____ Number of pits.__-./-------------Lining mater:_X- _ u Diameter__.w'•----._-.-----Depth_.y2 7'_/ 1` 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------------------------ --------------------------------------- -------------------------------------------------------------------- ` Remodeling and/or repairing{describe)=-- ------------- / W 5 � �- - ---------------------------------. ----------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ------ -------- ------------------------------------------------------------------------------- -- --- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County S ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------Alp-_- ---- - 1'ff��'- 'I Contractor) BY= ----------------- -- = _.: i (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ---------------------------------------- DATE--- a grp ----------------- -------------- ------- ------- -- ` REVIEWED BY-------------------------------- ----- - ----------------------------------------------------------- DATE---------------------------------------------------•-------- BUILDINGPERMIT ISSUED------------------------------------------- ------------------–----------------------------- ------ DATE------------------------------- ----------------------------- Alterations and/or recommendations:--------------__---------- --------------------------------•-------------------------------------------------------------- I ------------- -------------------- --- ----------------- -------------------------------------------------------------------------- --------------------------------------- ------------- --------------- FINAL INSPECTION BY- ------------ ----------- Dater L, � ��-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street , 4 ;. t i 132 Sycamore Street 814 North "C" Street Stockton, California Lodi California 4 Manteca, California Tracy, California f ES-9 2M Revised V59 FY Cc. 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