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FOR OFFIC 4.,d w---- - ------------ APPLICATION FOR SANITATION PERMIT Permit No. -- --- -------------------- ---------------------------------- ----------------------------------------- - (complete in Duplicate) I - .. - —Date,.Issued----------- ---------- -------------- ------ ------- --- —.—'Th-is-Perriiit'Expirei'l'Year From'Darelisued— AppliEation�s,hereby made to the San Joaquin Local Health District for a permit to construct and inlfall the work herein described. �plicafioni is made in compliance with County Ordinan No. 549. This a f e ...... - ------------ I---------------------------------i----------------------•------------------ JOB ADDRESS ANJ?NLOCATiONIV_X�/*�� ------------ Owner's Name-------- . ....... ............. -------------------------------------------------------------------- Phone------------_------------ ---------- ---------- ------------------------------------------------------------------ Address ----_------- ---------------- ---------- Phone----------------------------------- ------ ------------- - ------------------------------------------ Cont Contractor's Name. 1A Installation will serve: Residence 2-1Apartment House ❑ Commercial' E] Trailer Court E] Motel F1 Other E] Number of living u0nzifs: Number of be&ooms Number of baths S--- Lot size ---------------------------- Wafer Supply: Public syOern [Community system [] Private [] Depth to Water Table Character of soil to a depth of 3 fee+: Sand El Gravel [I Sandy Loam E] Clay Loa'm [3 Clay E] Adobe�-�arclpan E] Previous Application Made: (If yes,date-------------_.----) No New Construction: Yes [g�o El FHA/VA: Yes TYPE -OF INSTALLATION AND SPECIFICATIONS: .1(No septic tank or cesspool permitted if public sewer.is available within 200 feet.): SepticTank: Distance from nearest well-__---—"-:_--Distance from foundation---419---- �_ �--------- No. of 8ompartments--, ---f-e- _MPliquicl de�p ----------------Capac -------- ---Sizee&5� X depth_---- Disposal Field: Distance from nearest well---—--------Distance from foundation-_- .577`1 _--Distance 7-to nearest lot line_---)P;�_ f lines----_ ---------------__-_ Length of each line- f_- Width of trench--..2......--------------------- - p _?------------ -------- ---- - - : 1W D h f filter material--f ---_-__ Type of'ifilter maferiaL/ ept o .------Total length... -------------------------- Seepglg�_-t._ Distance fo nearest well----------;—-------_Distance from foundation-------------------Distance'fo nearest lot line----__`----- Number of pits--------r-----------:---Linina material-------------------I----Size; Diameter-----------------------Dept h----------------------- ------ C e ss po o I Distance fr6m nearest well- ----_ --!,__Distac' ftc;m-f6undzsfion��._ -------lining material-_----------------------------------- El Size. Diameter--------- ----------------------------Depth------------------------4�,--------------I---------------Liquid Capacity-----------------------------gals. _A( Distance from nearest well--------- ------- Privy:! ----------------L---Distance- - fro�nnearest6u'ilding------------------------------------------ ❑ Distance'to nearest lot line---------------------------------------------- --------- --------- ---- -- ---------------------------------- ing (describe):---------------- --------------------- Remodeling and/or repair ---------- • I I a 7---------------------- --------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------I--------------- ---------------------_-------------_--------------------------------------------- ----------------------------------------------------------------- --------------------------------------------------------w---------- ----------I---------------------------------------------------- ------------- -------------------------------------------------- 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,i and rules and regulations of-the____Sa`n Joicluin Local Health District. - ---------------(G4#aeP-aw#or Contractor) ' ---- - ----------- -�e , --------------------------- By:�------------------------------------------------- —A ------------- ...... (Signed)------ -------------- -- -- - --------------- - --- -- ------ ....... ---------------- - plan, showing size of lot, location of system ati n to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY Q...3__ _q APPLICATION ACCEPTED,BY------Lt Z5-- -----------------------------------------------=----------:DATE-----I --- ----------- -------------------------- REVIEWEDBY-------------------------------- -------------------------- ------ --------- ----- ---------------- ----------- -------- ------- L BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------_. ---------- ----------------------------------------------------I-------------------------------------------------:------------------------------------------- ------- --------------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------;-----------------------------------1------------------_- -----------------------------------------------------------------------------------------------`----.-----_------------__•-------••-------'----- ------ ----------------------------------------------------- ---------------------- ----------------------------------- - ---- -------------------------------------------------------------------------- ----------------------I........11----------- ------------ -------- ---------- FIN)cL--INSPECTION Date----- ----------------------------------------•---- j SAN --------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodlr California Manteca,California Tracy,California REV;8r.0 0-59 F.F,cC1.2M 6.60