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rL.jr, urt-lc,t UbL: ------ -------2------------------------------------- /72 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .... --------------------------------------------------------- (Complete in Duplicate) - 1, E!!This Permit ofres I 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 AND LOCATION ' Owner's Name Z,- ------------ -------------------- -------------------- -- - ------------------ ---- - -- ------ ------------------------- --------- one,,,�� Address' ------------------------- --- --------- - ------------ ,A -- ----------------------- ----------------------------- Contractor's Name ------------------------------------------------ ---------------- Phone Installation will serve: 'Residence Apartment House [1 F 4 - Commercial-El Trailer Court [] Mofel El Other E] Number of living units: --- Number of Sandy bedrooms ---3-- Number,of baths __2� Lot size ------------ Water Supply:� Public system Ej - []Community System El Private [9 Depth to Water Table _-2 ft. --------------- Character of soil to a depth of 3 fe�f: Sand ❑ Gravel F . ] Loam El Clay 'Loam Ej Clay [] Adobel& Hardpan C3 Previous Application Made: (if yes,'date----------I----------:1 No [, New Construction: Yes El No � PHA/VA: Yes El No,0 TYPE OF INSTALLATION AND SPECIFICATIONS' (No Septic tank 'or cesspool permitted if public sewer is available within 200 feet.) Septic. Tank: Distance from nearest 'rorn foundation-- Distance fMaferial__, _ No. of compartments-------------7 Size--- I; I ---4---Eiquid depth--------'I./_' Capacity..--,P- -----Z;:" " Disposal Field: Distance from nearest well---- ---Distance from foundation----�Zenp-_!-----Distance to nearest lot line-_-/. c3, Number of linesLength of each line------------- ......Width of trench- 2 Type of filter r,na, --;K4-e----Depth of filter matenal------/. --_----Total length------------- _Z�> ii Seepage Pit: Distance to nearest wall ----------------- _fouriclation'_Z,2_�------Distanceto nearest lot line--------2- C14 Number of pits. -----Distance from ----------L! ing ze:-Diam'efer____3_' ----.Depth------ --sA-------------------- Cesspool: Distance from nearest well___ ______r------Distance from foundation-- ------%.-11-------Lining material-----__ Size: Diamefer___,T1__, -----•----•----•---•--- - t€ ------------------I--- -!I ------------ ------------------Depth-------- -------------- ------------------------Liquid Capacity----------------------------gals. Pr;vy.- Distance from nearest well_____________________ .-.._Distance from nearest building--------------------•---•---------.-- El Distance to nearest lot brie_._----7' .. - ---- -----------------------------------•----•--------"-------------------•---• ----------------------------------- Remodeling and/or repairing (describe):--- , // ---------- ------------------------- -- ----- A ------- -- -------------- ----------------- ----------- ------------------------------------------------------------------------------------------ ------- ----------------------------------------------------------------------------------------------------- -------------------------- ---------- ------------------------------------------------------------ ------------------------- ----------------------------- -------------_-- j; ------------------------------------------------------I-------------------------------- -- ----------------- ------ ------ - --------- I hereby certify that I have prep'oared Ais'applicaffon and that the work will-be done in-'accord-a-nce--Wifh-'San-'J'oa'quin---County y- ordinances, State laws, and rules and I regulations Of the San Joaquin Local HealtWlDiffricf. ------7— :-Q (Signed) . . ... ----------------------------------------------------r--------------------------------------(Owner and/or Contractor) By:-----------_--------- -------------------------:j------------------------------------------_................ .........--------------(Title)--------- (Plot plan. showing size of lot, lo�afion'of system 'in relation to wells, buildings, etc., 6o placed on.-reverse- - - _.................. --------------- 11MIF195, Do placed on side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.__--_ ------------------ ------------------------------------------DATE REVIEWED BY --------------- ' ---------------------------:----------------- ---------- --- ----- DATEBUILDINGPERMIT ISSUED---------- ....... -----I---- — _:-------------m------ DATEAlterations and/or recommendations_______________________ .................. -------------x-_---------------------- ----------------------------------------- ------------ ---------------------------------------------------- ------ ---------------------------------------.............. -------------------------------------------------------------------------------I------------ ------ --- ----- ------ _:�--—----------------------------------------------------------------------- -------------------------------------------------------------- --------- -------------------------------------------------------� ------------ ---------------------- ------------ ------ -------------------- ------------------------------------------------------------ --- --- ----------------------------------------------------------- ------------------------------------------------------------- ------------- ------------------ FINAL INSPECTION -BY-------------- - -- -- --------------------- : --------------- Date = ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore.Street 205 West 9th Street Stockton,ColiFornic Lad),California Martleco,CaliforniaEE-9 REVISED 8-59 F.P.013,2M a.40 Tracy,California