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FOR OFFICE ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- ..,1..., .a�.0. ------------------------------------------------------- (Complete in Duplicate) f� -------------------------------------- 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 County Ordinance No. 549. JOB ADDRESS AN L TIO ..1---(-` 9 n..._...---••-----------------------------•-•------------------ Owner's Name-- ------------------------------- ----- ------------- Phone--------------------- -------- Address.---•-----• !. +_' ---------------------------------- � Contractor's Name.-•--,, -•-1---'`- --------------- Phone........... ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __.3_- Number of baths .1.---. Lot size --------/-47v-.14.0 _________________________________ Water Supply: Public system PKCommunity system ❑ Private ❑ Depth to Water Talelk5-�–?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ardpan ❑ Previous Application Made: {If yes,date--------------------} No New Construction: Yes P"o ❑ FHA/VA: Yes ❑ No 94-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T k Distance from nearest well-----------------Distance from foundation---------.......---.Material---•-------------------- No. of compartments----- --------------------Size--------------------------------Liquid depth---------------- ---------Capacity--------------------- Disposal Field: Distance from nearest well.lho�____Distance from foundation_,to_r__......Distance to nearest lot ��. Number of lines--------1------------------------Length of each line-------+.0--------------- Width of trench-----Ze:4----•-------------- Type of filter material.r-Zv_E_'(---------Depth of filter material____-/r______.____Total length--------$6-Q____________________-_-_-__ Seepage Pit: Distance to nearest --------Distance from foundation_-j&,'-j&,' to nearest lot line__6P_.f__ Number of pits--------t------------Lining matariaL_ p4°i ____.Size: Diameter-----J_�-X_F.------Depth------- ------------- Cesspool: ______-.-_ .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 '-4-------------------------------------•-------------•------- ------------------------------------------ Remodelingand/or repairing (describe):--------------------------------- ---------------------------------------------------•-----------------•-------------------•---•---------------------•-- --•--------------------•-------------•----••--------------------------•----------------------•------------------------------------------------------------•------------------------------------------------------------------- -----------------------------------------------•-------------------•----•-----.........-----------••--------------------------------------------------------------------------.---------------------------------------------- ----------------------------------- ------------------------•---------------------------------------------•------------------------------------------------------------------------------------------ ----------------------- 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 regulationl! tY San Joaquin Local Health District. Si ned -______._____.(Owner and/or Contractor) By:--------------•------------------------------ --------- ----------------•----------------(Title)---------------------------- ---------------- (Plot plan, showing six of lot, location ys em in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------------- --•------------ DATE--•---- ------------------------------ REVIEWEDBY--------------------------------- •-------------- ---- ---------------------------- - --------------------------------- DATE------------------------------------- BUILDING -- --••-•---.-----------..BUILDING PERMITISSUED--------------------------------------------------------------–-------------------------------------- DATE---------------------------------- trafj ns and/or recommendations----------- ----------------------------------------•------------------------------------------------------------------------------------------------ -------- i --------•--------------- ----- - ------------------------------------------•------ --------------------_--.--------------------------.-------------------------------- ---------------- - FINAL INSPECTION BY:----- ------ ------ Date--------- S-6/.------ .. ti 4L-X 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 E9-9 REVIEEO 8.59 F.F.CO.1M 6.60