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SE--- FOROFFICE USE- -------------------- ----- -- --- - ---------------r-- APPLICATION FOR SANITATION PERMIT P-rmit No. .__13!;!__ .. f -------------------- --- --------------------------- (Co nplete in Duplicate) ------ This Permit Ex ires 1 Year From Date Issued Date Issued .11.—�.0 .. � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----- I.-..—'- Owner's -•.-Owner's Name----------- ........................../Vol. -1?----•-- -/f _/ lJ/ r-------•-- --------- Phone................................... Address................ Contractor's Name •-�•--•------ -• ---•-•---•-•--- Phone.................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I_ Number of.bedrooms ---I-- Number of baths -------- Lot size ...... -_X.....`77:y : •--•••--•••-.----•- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: (if yes,date.-A'-Q----------1 No-O New Construction: Yes ❑ No a FHA/VA: Yes ❑ No,EZ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well---------- from foundation-------------------.Material --------_----......._-____.__.....-........-.._. No. of compartments-------------------------Size.--•--•---•----------- Liquid depth.--------••---------------Capacity----• I Disposal Field: Distance from nearest well-AM _e-Distance fr`o'm foundation__.t. a� ------Distance to nearest lot line.__- Number of lines____---_ .�-----_--_-----Length of-each line.--.......... -Q�_-- Width of trench.....---- .-...-.-._-- Type of filter material._.-- c _--Depth of filter material------- "Total length--------------- [A _._._•_--_--- Seepage Pit: Distance to nearest well...... /67 istance from foundation....�.0.1__-.Distance�o nearest lot line__-_- : �` r `~v Number of pits----------- material. --flt.-c—_Size: Diameter----_t -X ---_-,Depth_--.-_-....-I-0.-...._-- Cesspool- Distance from nearest well---------_--_-Distance from foundation---------------------Lining material------------------------------------- 0 ._.-----._- -- ❑ Size: Diameter--------------------------------------Depth-------------------------------- -------------------Liquid Capacity-------------•-------.....gals. Privy: Distance from nearest well -----------------------------------_---_-------Distance from nearest building--__----_------.___---_. ❑ Distance to nearest lot line----------------------------------=- -------------•------------•-•--••- -----------------•-------•--- Remodeling and/or repairing (describe):------------- ------------ --------------. ------------------._.-..- ----•----------------••-----•---•-••-•-•-•------- 1 ------------------------------------- -•----------••-----•--•------...-----•----- .........._.._-__............ --------------- ----------•----.'__-_-.___--...__.-.---------------------•--.-.----.---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sty I ij,,qnd rules and regulations of the San Joaquin Local Health District. G (Signed).--; --------- ------(Owner and/or Contractor) By-------------------------•---------------------------------------------- ------------------------------------------------------------(Title)-------------------------------------------- - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPf°RT T SE ONLY APPLICATION ACCEPTED BY-- ----- ---------------- ------------1 --- ------ -_----...-•--------------------------- — DATE-------��--••--f�J-----��.�..------- REVIEWEDBY------------------•------------------------------ ---- ----------------------------------------------------------.....------- DATE-------- BUILDINGPERMITISSUED------------------------- ---- ---------••--------------------------------------------------------- DATE----•--- Alterations and/or recom ndatio :-- - -------- ---------------------•-•••••-- � _ _ • r , ........................................--------------------------------------------------- --- ----------1------------------------------------------------ ----. FINAL INSPECTION BY:-_ .. ..2- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street y 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CB 9 REVISEC B•89 2M 6-61 ATLAB 1-