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DC— APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __ /- Application is hereby made to the'San Joa in Local Health District for a permit to construct install the work herein described. This application is made in complian wiunty Ordin nce No. 549. JOB ADDRESS AND CATION; _____ ___ __ �fl— z'______•-___ Owner's Name -- ------ ------------------------------- --------------------------------------------------- Phone-------------------------•--=------- Address------------------ ------ v2. ' ---- _ -- --------------------------------------------------- - / Contractor's Name ------- ---------------------------•----------------------- Phone. (�= Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of iivingunits: -------- Number of bedrooms -------- Number of baths -------- Lot size _t__�________________________________________________________ Water Supply: Publics,stem L_r�,/Communit system ❑ Private ❑ Depth to Water Table / ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam F] Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes to ❑ FHA/VA: Yes ❑ No ❑ w 5 ! TYPE OF INSTALLATION AND SPECIFICATIONS: x ! (No septic tank or cesspool permitted ifublic sewer is available within 200 feet.) Septic T Distance from nearest well` -Dista/ncc'e.from fougdatiof.._ =°.,Mate�ai- ` � I [ No. of compa=tme0s________-- -_ S'iz8!' __..... ___.7Z- 7Liquid depth____J'._----..______._ apacity1 __4 . Disposal RId: Distance from nearest w,�el1 _ I)Istanc,from foundation____5_F_ _____-Distance to nearest.ot ling__ 0/ Number of {fines------- ----------- Lengfh of each line--f4 ------------------ Width of trenc}i---- --------------------- Type of filter material__-_ . � hof filter material__ ; -------Total length______ _-mss ________________________ Seepage it: Distance to nearest welL�_- ---tistanc m,.fyiundation__,.�`_7-._.___.Dist nce to nearest lot line--___.-___---._ I Number of pit,-- _______- .L nin9�materia_'_ '" _f/__.Size: Diameter___ _��____.Depth_____ --___________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material-------------------------------------- 0 Size: Diameter-------------------------:-----------.Depth----------------------- --------------------Liquid Capacity...------------------------gals. i Privy: Distance from]nearest well-------------------------------------------------Distance from nearest building__-----___.____________________________._. {� ❑ Distance to nearest lot line------ --------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (des ribe}:------------------ --------------------------------------------- ---•-------------------- ----- - -------•----------------------------------• ----------------------------- �------` '-----------7�------------- ---I--------------------------------------------------------------------------------------------------------------- -------------------------- -----------------------=- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereb c rtif that !_have 'repared this application and that the work will be done in accordance with San Joaquin County ordinances, tae ws,-an rules and regulations of the San Joaquin Local Health District. (signed)---------- •- - ---- --- --- --- --- j - -------- - -------------------------------------------------------------- ----- -(Owner and/or Contractor) ---$ --____--Title)- r (Piot plan, showing size of lot, locati n of system n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------- -- - - ----------- --------------------------------------------------- DATE--------- --- REVIEWED BY--------------------------------------------- `- - - - -- - --------------------------------------------- DATE---------�- -�'��-'-- -------------------------------- BUILDINGPERMIT ISSUED------------------------------- ----------------------------------------- DATE---------- Alterationsand/or recommendations: ------------ -------- -------------------------------------------------------------------------------------------•-------- --------------------------- - 1!�1 � ------- ` _�J_A - � 'l - r --- ----u� -H1-----------� .----- -� ----- 'gar --------- -��A _�. r '------------------------- ----------- ---------------- /� `FINAL INSPECTIDate----- 7--- ------------- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California , ES-9-2K4 Revised 1.57 f-P.CO.