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FOR OFFICE USE: I 5 Y��_,------------------------------------------------ _.----------_--.----.-- ------. APPLICATION FOR SANITATION PERMITPermit No. --- ------------'------- ----- -- --------------------- (Complete in Duplicate) 7 Date Issued ___ ---------- This Permit Expires YYear 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 ca�tio-n Cis made in compliance with County Ordinance dinance No5A4p9. 10 pa' Zr O --fa OB ADDRESS ANOCATION ------ e �y= Q------ /1r"C Own3-l -D-- --- --- •--- t 2 's Name ----- - - - - --- Phone-----•----------------- ------------ Address � - r - ff Cont 4actor's NameJ..�tom`- -- --- ----------- Phone--------------------- - ------------------------------------ -------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [[ Trailer Court ❑ Motel ❑ Other 1 Number of living units: j----- Number of bedrooms _"____ Number baths Q __________ ------------------------------ ?___ Lot size _________ __ ____ Water Supply: Public system El Community system E] Private [Depth to Water Table -------- fWAdobe Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E-] ClayLoam E] Clay C] Hardpan E]Previus Application Made: (If yes,date.___..__..,_-__._-) No E] New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No E:1S TYPE I OF INSTALLATION AND SPECIFICATIONS: --R • "ln (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C) SeptVV tic nk: Distance from nearest we`l�_`SQ________ Distance from foundation-j-0 _J �- Material___ O.(-q—_________________________- M No. of compartments_____T____________ ______Size#6-J 7 XJ' :_-__ Liquid d de th______�-_ _ / - --- - - --t q P. -- - --------..Capacity_34-ems - Dis, t ield: Distance from nearest well ,/0_�_.-Distance from foundation/�'-_______.Distance to nearest lot line_�fy_----_____ Number of lines----=----- ---------------------- Length of each line--------,7✓r�------------.Width of4reach----- --------------------------� Type of filter material-------1�' _-i------Depth of filter material---------19____......Total length_____ _____________________� f / See p e Pit: Distance to nearest,well___fP�-__......Distance from�7 foundation----/jp_______.__.Distnce to nearest lot liner_____.___.-eb Number of pits-_--_--/.----------Lining material----�iR...___.__.Size: Diameter----��-_---------Depth-_---��.-5------------------- -"�. Cesspool: Distance from nearest well---------------_Distance from foundation-----_-------- ._..Lining material--------------------------------c:ip Size: Diameter-------------------- ----------------Depth-------------------------------------------------------------------------Liquid Capacity- - ------------- ----------gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest building------__-_-_--_--_____________________--- Distance to nearest lot line-- ------ ---------------------------------------------------------------------------- --------------------- Remo deling and/or repairing (describe)---------------------- ----------------------------------------------------••--------------------•-------------------------------------------------------• ` -----------------------------------------•--•-------------------------------------------------------------------------------------------------------------------- -------------------------- 11 --------------------------------------------------------------------------•-------------------------------•- --------------------------------- •-•-----------------------------•-----• -------- ----------------------- ------------------------------------------------------------------------------•------------------------------------------------------------------------- 1, hereby certify that I have prepared-#his application and that the work will be done in accordance with San Joaquin County ordinnces, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -- .... and/or Contractor) By:._----- -�--- -----`----------- --- --- - - ----�-- - -------- -- -----------------------------(Title)--- ------------------------------------------ - --------- .. (Plot plan, showing size of lot, location of system in gelation to wells, buildings, etc., can be placed on reverse side). Ih ' FOR DEPARTMENT USE ONLY APPLI ECATION ACCEPTED BY-- ------------------------------------------------------------- DATE--- -A� G ------------------------------------ REVIEWEDBY------------------------------------------------------------------ --- ----------------------------------------------------- DATE---------------------------------------------------....---- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.-------------------•--------------------------------------- Alter ations and/or recommendations-------------------------------------------------------------------------------------------------••----•---------------------•------------------------------ ------- ----- --------------------- ----------------------------------------------------------------------------------------------- ----------•---•-------------------------------------------------------------- ----------------------------------------------------------------------------------- --- ---------------------------------------------------------------------------------- ---------- ---------------------------- u �I---------- ------------ - ---------- --------------------------------- - ------ ._ . . --------------------------------- �6 . FINAL INSPECTION BY:- -.-f-�---'-'>'�•-------=----- Date ' ( .--- -- ----------------------------------------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hai*lton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I CS 9 REVISED B-59 3M 3-'r.3 F.P.CU. I