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d1t4 . -. �' _#_ 6S-7 -- \. V APPLICATION FOR SANITATION PERMIT -v9 ' Permit No: (Complete in Duplicate) } ` This Permit Expires 1 Year From Date Issued Date Issued ___ ___ ____________ f 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. 54 JOB ADDRESS AND LOCATION---- •-19------ Owner's Name--- - i---- ------------------jok ------------ Phone Address-------� ------------------------------------•---------- - ----------- Contractor s Name--------------- __ Phone-----------_---------------------- Installation will serve: Residence &Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - y Number of living units: _�___ Number of bedrooms �, -- Number of at s _ Lot size _ -e �"'�--------------------- Water Supply: Public system ❑ Community system ❑ Private & tepth to Water Tableff'�it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe2R-`FTardpan ❑ Previous Application Made: Yes ❑ _No New Construction: Yes ®/No ❑ FHA/VA: Yes [ 10 ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic,Tank: Distance from,nearest well-1410. Distance from foundation----Ile---------Material____ 1 -------Ca acit ZZP 0---- �� No. of compartments___ -----------------Sizej,�{_, _ - Liquid depth____ _____._.._ p y-- - ` ' � ,1 Yom... Disposal Field: Qistance from nearest well_' _.__.__Distance from foundation__. .____Distance #o nearest I� line__ _ Number of lines_______-0_ -------- 'Length of each'line__;?� : _-.Width of trench.._ ___________ __ Type of filter material 10Yx �--Depth of filter material__/A&*----___-.Total length_____.rd�rb,'�%a �------------------ 7 '-' __________--__- , J / • Seepage Pit: Distance to nearest well-_/W -__.___Distance from fou dation___�P_-------Distance to nearest I t une______-. __Linin material_ -Size: Diameter_ ��__--__-Depth___ Number of pits---�------- g �. -------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- ._____________. {f' ❑ Size: Diameter--------------------------------------Depth------------------------------------------------.----Liquid Capacity----------------------------gals. i Privy: ` _s, Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- �- --------- Remodeling { ❑ ��Distance to nearest lot line---------------------------------------------- ---------------------- ---=- ---- -' Remodeling `and/or repairing (describe) ---------- - -------------- -------------------------------------------- --------------------------- -------------- -----------•-------------------------------------•----------------------------------- I ..a 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, and r les and regulation's- of-the San Joaquin Local Health District. �.7� � - � r Contractor),---- -- -- --- ------- -- --- ---- T ( - --- -- � om -- ---------- � . - BY - - (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR D PAR ENT USE ONLY APPLICATION ACCEPTED BY--- z�xrL / ---- DATE--- ` ------ ' REVIEWEDBY------ ---------- ------------------- - - -------------`----•= '-------------------------------------------------- DATE ---------------------------- BUILDING PERMIT ISSUED------------ ----------- 1.---------•---------------------- DACE Alterations and/or recommendations:------------------- =-- ------------------•----------------------- ------------------------------------------------------------ ----------------------------•------------------------------------------------------- ------------------------------------------ -------------••-------------------------------------------------------- ---- NAL INSPECTION BY:-. > . , ct�*--------------------- Date---- f U-� r� -------- ------------------------ �. SAN JOAQUIN LOCAL HEALTH DISTRICT 4. 130 Soufh American Street 300 West Oak Street 132 Sycamora�. r 814 North "C" Street I Stockton, California Lodi, California Manteca. California Tracy, California ES-92M Revised 8-'S9 F.P.Co. -