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=710 — - ,7---- -= F-- ,J,-POR FFICE USE.. f L_ % 3a 2- --- -�.,��uu�,•,---��--- ---- . . . � { ~� • Permit No. ... ..; f - ---------------- APPLICATION FOR SANITATION PERMIT -------Y'--�-- --------------------------- (Complete in Duplicate) Date Issued ---- -------- t This Permit Expires 1 Year From Date Issued i. ,r �r j Application is hereby made to'-the San Joaquin Local Health District for a permit to const uci and istall the work herein described. This application is made in compliance with County Ordinance No. 549. �! I E JOB ADDRESS AND L CATION----------- ` Owner's Name------- -- - ---------- Phone Address------------- -------- ---------------------------- ------------------------------------------ / � ' Contractor's Name----- �. __.r - Phon .. .`Installation will will serve: Residence Apartment House ❑ Commercial,❑ Trailer Court ❑ Motel ❑ Other ❑ ll Number of living units: _V___ Number of bedrooms ?-- Number of baths .1..-- Lot size t___f�_y �!� �Q Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table:?VQ ft. Character of sail to a depth of 3 feet: Sand E] Gravel ❑ Sandy�Loam E] Clay Loam'(] Clay C3Adobe�` Hardpan ❑ Previous Application Made: (If yes,date--------_-i.___._._} Nox New Construction: Yes ❑�r No FHA/VA: Yes ❑ No El W TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tis k^ Distance from nearest well_________________Distance from fou ndation-------------------.Material__------______-_________--___________.______..... No. of compartments---------- ------------Size---------------------------------Liquid dept`---------------- ---------Capacity--------------------- ty , d: Distance from nearest well_?Zoxe.Distance from foundation.-._,41;!�-----.Distance to nearest lot lin_e.le ......_ Number of lines----------- _ Length of each line.... ------_fr-----Width of trench_____ _ __________________ r'. Type of filter material__ t_ j =Depth of filter material_____ _ _______Total length___-____ Q---------------------•-- W }; Distance to nearest well_ j24.Q ----Distan m f nda#ion___. _Q_�__.Distance to nearest lot Number of pits------1---------------Lining materials ..Size: Diameter----3-- .........Depth----.d - - -----------•--- Cesspool: Distance from nearest well___________i______Distance from foundation---.---------------.Lining material._.-----------------.___________-____ ❑ 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)--- ----------------------------------------------------------------------------------------•----------•------------------------------------------------ ----------------- ---•--•--------- ------------------------------------------------------•--------------------------------------- i - --------------•-•-------- -- ---------------------------------•--------•-•--------------------- ------------•------------------------- ------------------------------------------------------- I hereby certif t I have prepared`this'application and that the work will be done in accordance with San Joaquin County ` ordinances, .StAlawdreg tions of the San Joaquin Local Health District.(Signed)___________ Y__._ ___ caner and/or Contract--- -- ----- - -- - ` (Title)----_ t (Plot plan, showing size of lot, location of,system in reation to wells, b +dings, etc., can be placed on reverse side). h FOR DEPARTMEN USE ONLY J = ------ DATE- APPLICATION ACCEPTED BY-------------- ----- --�!_'------ ------------------------ REVIEWED BY----- - --------------------------------- ----------------- -----= ---------------------------------------- DATE--------•----.._.------------------------------------------- ! BUILDING PERMIT ISSUED-------------- ------------------------------------------ r-------------------------------------- DATE----------•---------------------------- -------------------- Alterations and/or recommendations------------- ---- ---------•--------------------------------------- ----------------- -------- ------------------------------ ----------------- ---------------- --- -------------------------------------------------------------------------------- Il z r ..,...--._.F r .. 3= _______________________________________ ____________________ _ _______4.k_______.__________-_._____________.-__-____...__._.___________..._.______.._____. ___________________________________ _____________ _____________ '__________________-_...____._.1.___-__--____._._.._______.._._.___.____...__--________L______...--___4__..____...____ _.__.__________.._. / ! --------- ---- -- -- ------------------ FINAL INSPECTION BY:------- ;---------- _--• Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Stroot Stockton,California Lodi,California Manteca,California Tracy,California ES-%REVISED 0.59 F.P.CO,2M 6.60