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FOR OFF U-S -------- -------------_---_----------- _____ APPLICATION FOR SANITATION PERMIT Permit No. .-. _. (?__, _� --------------------------------------------------------- (Complete in Duplicate) Date issued ..-YI ----------------------------------------- ------------ 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. .SOB ADDRESS AND LOCATION...-_-5_&0_.—//0---(f------ OCATION... &0-- //0---(------ °' -.P ---------------- ----------•-----------------------------...------------------•---------------.--------- Owner's Name----------d -tai - ----------------- -----. Phone------------------------------------ Address------------ ----•----------••-•---- - Address------------ -•--•-----------------------------------------------------------------------------------------------------•---... ................. Contractor's Name------------- J ----- Phone...........__--•---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ - Number of bedrooms _,�_=-_ Number of baths 4---- Lot size ..._- -- --!_ '?-------------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ,_' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0" Hardpan ❑ Previous Application Made: (if yes,date--------------------) No [Z- New Construction: Yes 0,110 ❑ FHA/VA: Yes ❑ No [`}- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic anli: _ _ Distance from nearest well--------------- Distance from foundation----.-_..-__----.--.Material-----------------_------------_ ------.----_---. �y No. of compartments--------------------------Size-.-_-------------------------Liquid depth--------------------------Capacity---•- •------ r Disposal Field: Distance from nearest well_ rar, ---Distance from foundation..1 a------------Distance to nearest lot Ek Number of lines----------I----------------------Length of each line---------a3_ -----------Width of trench...... y.r.---_------__--.-_ Type of filter material _"7 tzC --------Depth of filter material----1_F-----------Total length--_---&.,�;--_--------------------__-- t Seepage Pit: Distance to nearest well_-ni_r_--�--_-__Distanceefr�om��fo nidation---LI2...........Distance to nearest lot iine__.__�_-..--.- ❑� Number of pits---------I-----------Lining material__-_-!��f�'----.Size: Diameter---// ,--- _----.Dept h--..---�r��f----------. 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---------------.-------------------------- t ❑ Distance to nearest [of line--------------------------------- ----------- --------------------------------------------------•---•---•-------- ---------- -- 4 Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------•--------------------------------------------------------••--•- �I ----------------------------------------------------------------------------------•--------•--------------•-- ----•-•---------------------------•-- ---------•-•-------------------------------------------------------- I 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 regul tions of the San Joaquin Local Health District. (Signed)--------------------------------------------- ------------------------- ---------------- --------- - - ---- -------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------- -------------------------------------------------------------------------- • (Title) --- ....... ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `L APPLICATION ACCEPTED BY------- -- -- ------ --- ---•-------•----------•---------------- DATE--------'% ---------------- REVIEWEDBY--------•-----------•-•---- ------ - ---------------------------------------------------------------------------- DATE-------------- -----_------------------ ------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------._..___---•------ --------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------•-----------...------•-•--•---------•------- ------------•-----------------------------------•--•--•--•---------------•--------------------------------------------------------- -•--- -------•------------------•------------------------------------ <t _ `------------------------------------------------------ ... . . .. 7 1 1 -- ------------ FINAL INSPECTION -------- - -- -- -- - ------- --------- Date------ a P�_---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California EB•0 REVIVED 6.59 r.P.00,8M 6-60