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�O7 FOR OFFICE US : ------- ---I------------------------------------------ APPLICATION FOR 'SANITATION PERMIT Permit No. .__....._. S --------------------------------------------------------- (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. t This application is made'in compliance with County ) � Ordinance 549, - --••-----------------------------•--------- i 41�*+ t rJOB ADDRESS ANDAT N QN e 47 Owner's Name------------ - C --------- Phone---------------- •--•-------- Address------------ .. --------------------------=------------••----••------------ Contractor's Name-------------- �� - - --,----------------------------------------•-------------- Phone Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ :: Number of living units. ___�__ Number of bedrooms ._a- Number of baths ---/- Lot size _____� " '`------------------ Water ---------- -Water Supply: Public:system ❑ Community system ❑ Private Ej-�epth to Water Table A14 ft. Character of soil to a depth of 3"feeti- Sand E-]--Gravel [-]'*Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M—Hardpan ❑ Previous Application 'Made: (if yes,date--------------------) No P----N-ew Construction: Yes [i-'14o ❑ FHA/VA: Yes ❑ No ❑ 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----1_Q__.-------Materal. _ ___ I ______________ __ No. of compartments_____ city--- -____Size_-Iv � --�•------Liquid dePth____-� _____ _ _-.CaP, Disposal Field: Distance from nearest well.._ir _.--.._Distance from foundation..472 � Distance to nearest lot line___r ___+r_____-____ Nusmber of lines__'____/._ s' _ Length of each line_____-- -��_____.Width of trench________ ___ _____ -------------- 01 Type of filter material.' - -C.G�'__._.Depth of filter material.__ __-______-Totallength_____ ____________________________ 7 r e — Seepage Pit: Distance to nearest weil_,,/_0l''D----------Distanc _ f undation_ kdV__ - Di?fa�ncp to nearest lot g _ _________ Nimber of Rits.-- lLining materialG .__.5ize: Diameter/ _ DePth------- ----------- Cesspool-. , Distance from nearest well-----------------Distance from foundation---------------------Lining material-__-----______--____________________- ❑ Size: Diamet6 r---- --------------------------------Depth----------------------------------------•-----------Liquid Capacity----------------------------gals. . Privy- Distance from nearest well-------------------------f______________________Distance from nearest building.____.._______.____.-_-----__-_-___._____- t Distance to nearest.lot line ---- ------- -------------------------------------- -------------------•---------------- --------- -- --------------------- ---- s � t � t Remodeling and/or repairing (describe=d- --------- ------ -- --•_•------ i t .l • ------------------------------------ ---- --------------------------=------.--' ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- i I her ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc S. St to laws; and jules and regulations of the San Joaquin Local Health District. aAA(Signed) -----=--i----" =� - A-. ner and/or Contracto r Bi .-- ----------- y:--------------- -----------. .. --(Title)-- - (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ¢- APPLICATION ACCEPTED SY_-': i '--------------------- --- DATE----------- 3-40--- ,C�_Z------------------ REVIEWED BY-------------------------------.... --- ---r--- --------------------:----------------r-------------------------------------- DATE-------------`------ --- ----------------------••------ BUILDINGPERMIT ISSUED--------=---=1- ----------------------------------=----------------------------------- DATE-------=-------- ----------------------------------- AI dans and or recommendations:^ ------------ ----------------------- ---------•---•... ----•- -----.----• .......... -------42 . �- ---------�---- ---------- _--�" *,. /� -G-�L,----------------------------------- 1=1NAL INSPECTION BY:.. - - (� Date <. /ok t ZN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California I Lodi,California Manteca,California Tracy,California E6.9 Reviaro e-59 r.p.00 2M 6-60 l r J