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FOR FFICE U E:u • -----�„- --- ----- -----? Permit No. _ � � �: ----- > _ ---- ---------------=----- APPLICATION FOR SANITATION PERMIT . ---- --------------------------------------`=-----------.----Y [Complete in Duplicate} - j This Permit Expires 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 herein described. This application is made in compliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATIO � -•--------- -- ----- --- Owner's Name 11.� ----- Phone.. ` �1,4�t --.... —------------- -•------------------------------- ------ ------...-------------a------------------------------------------•-----•----------------•-------•-------•-.................. Contractor's Name 4/ .... •------•---•------------------------••------ Phone----------•--------------•--------- Installation will serve: Residence Og'--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms --21 Number of baths j-------- Lot size _. - Q-.-..•--------------------------- Water Supply: Public system ❑ Community system ❑ Private [ff--l5epth to Water Table t!P- 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 [P--New Construction: Yes O"o ❑ FHA/VA: Yes ❑ No M-------- . r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Se ti Tort Distance from nearest well-----------------Distance from foundation--------------------Material_------.------------.-------.---_---------------- ,E No. of compartments---------------------- Size-------------------------------Liquid depth--------------------------Capacity----------------------- ?� ! 1 / i ;* Disposal Field: Distance from nearest weli�----------.Distance from foundation-1 ---_.-----..Distance to nearest lot line-�3__rrtti!ty� [ � Number of lines.-4.----_---t--------------------Length of each line----iJ.....----.--.......—.Width of french-.---�-�'.-------------------- Type of filter material-'—?"7,d-------Depth of filter material -_-/?'-- ---------Total length------sS-P---------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----.-------.--._ ❑ Number of pits----------------------Lining material----------.------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-..---_------.----------_----__----- 4 1 ❑ p --------------------Liquid Capacity----------------------------gals. Size: Diameter--------------------------------------De th-------------------------------- Privy: Distance from nearest well------------------------------------------------- from nearest building-----------------_------_------.---.---.-. ❑ Distance to neareist lot line------------------------------------------------------------------------------------------------------------------------------------------- - i Remodeling and/or repairing [describ------------ -----------------•-----------------------=-----------------------------------•------•------•------•-------------•------------------------- t I --------------------- -----------------------•---------'-------•---------------------------------•--- ------•-----------------------------••--•-----------------•--------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rul nd egula#ions of the San Joaquin Local Health District. (Signed) ----- --------------------------------------------------------------------------------------------------------------(Owner and/or Contractor] By=--------------- ---------------------------:(Title} (Plot plan, showing size of o+, location o system in relation to wells, buildings, etc., can be placed on reverse side). r 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ' -- ----------------------------------------------------------------- DATE------ ------------------- REVIEWEDBY--------------------------------------------- ------------------------------ ---.-------------------------------------------- DATE---•---•----------------------------------------•--•------- BUILDING PERMIT ISSUED-------------•------•-----------------------------------------—--------------••------------------ DATE------ ----------------------------------------------------- Alterations and/or recommendations-------------- ------------------------------------------------------------------------------------------------ -------•-----•-----------•-------••-----------.- ---------------------------------------------------------------------------------------------------------- -----------------------------•---•..........----••------------•-•---- --------------•-----------------------.... it I FINAL INSPECTION BY:. '�/( - Date...........-1.-.. -------- - /---------------------------------- s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E13-9 REVISED 8.69 F.P.DD.SM 6.60