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FOR OFFICE USE: 3 3 �' --------------- I [-�-i _________ APPLICATION FOR SANITATION PERMIT Permit No. .................... h ---------`�>1z��...... '----- (Complete in Duplicate) �- { ,• -------------------- 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. S49. JOB ADDRESS .AND LOCATION _ ..... Owner's Name-----41e, ----- . Phone------------------------------ Address---•.-rr- ----- } Contractor's Name--•- ` '.. lP ------------------ �` •-------- Phone--------------------- Installation will serve- Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ ^ Number of baths _-- Lot size .0-.400c_L •........................... Wafer Supply: Public system ❑ Community system ❑ Private g?"bepth to Water Table 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 59�--New Construction: Yes ❑ No jg—FHA/VA: Yes ❑ No W— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation'..._____-_------.-Material-------------------------------------.---------- �e %/hf No. of compartments----•------•--------------Size-------------,"----------------Liquid depth-------------------------Capacity....................... W Disposal�FiQid: Distance from nearest well.................Distance from foundation----................Distance to nearest lot line.___....._.-_-- � S/f 41 Number of lines-----------------------------------Length of each line------------------------------Width of french-----------------------.---------.- Type of filter material.........................Depth of filter material-----------------------Total length....-...._---....__....._-.-__...___....._ i Se page Pia: Distance to nearest well/A1.-----.-.-Distance fr94n foundation..��..------....Dijstance to nearest lot line__�P./ s ,./��'S��f � Number of pits------/-----------Lining material._ �ye .Size: Diameter.....f�Z.._.-----Dept h-_.. ✓ ----------------- c spool;, Distance from nearest well-----------------Distance from foundation--------------------Lining material_..-.---------..--_..._-.-.-.-...._.. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- 0 Distance to nearest lot line.--- ------ -----------------•..................... ------------------ ------------- ----------------------------------- �. - �- Remod ii and/or repairing descri ):----------- 7 _..--•- • �- --•----- .. - -------'-------------•----------------- --•--- ------- ------------------------------------------------------------ ---------------------------------------------------••----------------------------------------------------- -- 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 regulations of the San Joaquin Local Health District. (Sig ned)--------------- -- f4_ _+ j--- --------- --------•--------•--;---------- or Contractorl By:. ----------(Title)--- �-1 (Piot plan, showing size of lot, location of sysfe ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------- -- -- --- --- ------------------------------------- DATE-----ft------------- ----------------------------------- REVIEWED BY-------------------------------------------- ---- ---- - ---- DATE --( 1 r, - ---- -- ------- BUILDING ------- BUILDING PERMIT ISSUED--------------------------------------------------------------–--------•-------•-- —---------------- DATE-------•-----••----- Alterationsand/or recommendations:--------------------------- ---------- ---------- --------------------------------------------.------------.....------------------------------- /;: //� e ' - - HT1----- --- _; i � -.... �- -------------------- -. "'°` `" --- �- _ -_ � -. -� FINALINSPECTION BY----------------------------------------------------------------- Date-------------------------------------------------------------------------------- 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 EB•9 REVIBED 8.69 r.P.00.2M 6.60