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' FOR OFFICE USE: _______/©�-_-7- APPLICATION FOR SANITATION PERMIT Permit No. ...1�._L,�J E---------- ------ ------------- (Complete in Duplicate) Date Issued ----f� •-- 6 .....------- ---------------------------------------_-..-- This Permit Expires 1 Year From 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.../1 .. � � .-. -..�M -.�?� II L �� _T OwnersName-----//--•-L'/'---. -•-•--------------------•----------------------------------- --- ------------------------ Phone---------•----.--__ - i Address---------------------------------------------------------------------------------------------------------•-----------•- ------•------ Contractor's Name--------------O� f i ------ •--------- ...... ••---- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ,-_- - -�---------------------------I-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 6_4-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EY-IH-ardpan ❑ Previous Application Made: (if yes,date--------------------) No New Construction: Yes [A--No ❑ FHA/VA: Yes ❑ No [�- TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic T nk: Distance from:nearest well-XP---------Distance .from foundation_&--------------Material---- ----------------------- [ No. of compartments----------3------------- ----Liquid depth----- --!--------------Capacity__A_.P _-_rb_r.�,1® Disposal Field: Distance from nearest weil.�- ........._.Distance from foundation./.� ..............Distance to nearest lot line.. ...... � y [� Number of lines------------- ----------------Length of each line---Z�p--------_--__-_--.Width of trench---.-Z_�Y_*----------_---._-- ;C Type of filter material_ -TOCAt-------Depth of filter material----1-$----_--------Total length_-_.- off--------------------------- s Seepage Pit: Distance to nearest well__ ca-------------Disfiance from foundation__lb -__Distance to nearest lot line_. - "� f o Number b um Nits_-_----- p •`�--------Loring mate rial----�Q-C'�----.Size: Diameter--- ---------------.Depth Cesspool: Distance from nearest well from foundation-.-.-.----.---_.-_-.Lining material-----------------___-._-_.-.-.-.._.-.-. Size: Diameter.------------------------------------De th------------------------ -----------_Liquid Capacity t--gals. k Pit ❑y; l '---...__-.••-_--Distance from nearest building------------------------------------------ Distance to nearestlot 1ne---------------------------- ---------------------------------•-•----- .......--•--------•------•-------------------------------------------- [I , I y � Remodeling and/or repairing (describe) ------------------------------------•--------------------------------•---------------=•--------- ••---------------•---------- -----------....------ -----------------------------------------------------------------------•---• -----------•-------------------------------------•-•---•--•-----•----------------------•-- 5 l ----------------------------------------------- ----------------------------.-------------------------------------------------------------------------------------------------------------------------------------------------- r EI I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ati s of the S Joaquin Local Health District. (Signed)----••-------•------------------------------------- ----- ------------- -- -----------------------------------------------•--------------------------------(Owner and/or Contractor) E r I f By%_--------------------------------- - ----------- •--------- ----- - - -- - -- -----------(Tit10)-----------------• �----------------------------- ------ ------- (Plot plan, showing size of Io , oca ' of system in relation to wells, buildings, etc., can be placed on reverse side). r :a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- DATE-----��--�--- �� --•---•- --------- APPLICATION BY------------------ ------------- ------------ ---------------------------------------------------------------------------- DATE---•-------------------------------•. ----------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- -------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- -- ------- -- ---"------=---._..---...... =----------------- -----------•-•----•-------------------_-•------------------------------- --------------------------•------------------:----•-•----------------------------------------------------------I------------------------------------------------------------------------ --------------••---................. .,w.. _ ------------------------ ------ --------------------------------- ------------------ -- ------------ ----------- •-----•----------------------------------...------------------------------------- rFINAL INSPECTION BY:- #--------- Date------lxa-- *---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT x 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street w Stockton,California lodir California Manteca,California Tracy,California 4� E6.9 REVISED 13.59 F.P.C4.:,M 6.60 -