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F FOR OFFIC&USE:00 ------------------------ ----- --,." ' I ._---- APPLICATION FOR SANITATION PERMIT -------- .-� .F (Cariiplete in Duplicate) ��31 r< y Date Issued ........... . . ------------------ -------- -------------------x_-.-_' _.__ This Permit Expires 1 Year From Date Issued Application is hereby made 4o 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. F JOBADDRESS AND LOCATION ---17996'- A ----- -------------------- -----------•------------------------•-••-----`-----------•--------------------•-------- -&_c - Phone- -----------------------•--------- Owner s Name--------- - - ..�.- .� ..:.......�--------------- - ------------- -- Address-------•-------J--ain---t------------------ ` _.. - Contractor's Name ----47 X0,0_ -k -----•---•---- --•------------•- ----- ------.-.--•------•------ Phone ------------------------------------ Installation •-•-----------•------•-••-•------.Installation will serve: Residence EA --Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i dX / Number of living units: ____�,._ Number of bedrooms _�.-_ Number of baths --- I--- Lot size ______________l�_____.......--------------- ......... Water Supply: Public system (�.ommunity system E] Private ❑ Depth to Water Table .: JJ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam [I Clay Loam [I Clay [I Adobe �ardpan ❑ Previous Application Made:; Ilf yes,dat----=------- --- -) No.�New Construction: Yes [ IVo ElPHA/VA: Yes ❑ No ®—�^ TYPE OF INSTALLATIONAND SPECIFICATIONS: (No septic tank e or cesspool permitted if. public sewer is available within 200.feet.) „ I � ` Septic Tank: Distance from nearest well -----------------Distance from foundation ------------- .------ Material ----------------------------------- ._._.._.._---- ❑ No; of compartments -------------------------- Size -------- ----------------------- Liquid depth-------------- - ---------Capacity---------------------- Disposal Field: Distance from nearest well Distance from foundation._I4"r"____Distance to nearest lot line__ _._____ a � ---------------- TypeNumber of lines __________________L_.--.------- Length of each line ---- of trench.-___._ _ ______-_..._______-.___ Type of filter materiaT7p__e_K-----_-.,_Depth of filter material -/J" --- ---------- Total length _---___--&7_-_____________________ Seepage Pit: Distance to nearest well_:'-'-- -Linin .. Distance from jjound tion..- U. zD�stance #o nearest lot line --- TJI g smateria . 4G` xe: Diameter Depth �l p �, r. . Cesspool: Distance from nearest well ----------------- Dista ce from ndatio� ,�-__-----.Lining material__. -_.------__----_-_--_--_------_- Distance from nearest well--------------------------------------------�--Distant J "`----- - ----Liquid Capacity --•---------•--•-----------.gals. ❑ Size: Diameter -------------- --------------------Depth-------------------- Priv } µ e,from nearest building ❑ ------------------- - Distance to nearest lot line---------- ----------------------�'--'- Remodeling and/or repairing [describe):--- ------------ ------------- /--------------------- ----•--- ----- -----------•---•----------------- •--------------------------- --------------=----------------- --------------------------------------- --------- --------••---- ----- r----------- + ------ - -------------------• •---------------••-• •-----------------------•-•----'-------------------------------------------- - ------ I hereby certify that f have prepared this application and that. the work will (be,,done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -.---f -gam(Owner and/or Contractor) (Signed)--------. -------- ------ --------- -------------------------------------- -------- :: ---- -------�----------------------------------------(O pn gy;.- ---..- :.--------------- •--------------------------------- - ;--=-------=----- {Title) ` (Plot plan, snowing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U§E ONLY x 1 APPLICATION ACCEPTED BY '-°------------------------•---------- DATE-- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------- ----- DATE BUILDINGPERMIT ISSUED ---------------------------------------------- ------------------------------------------------------ ._. DATE------------------------------------------------------------ Alterations and/or recommendations: --------------------------- •- `� ' ------------ ---- ---- -- ------------------------•------------------------------------------------ _ ------------------------------------------------------------------------------------------•--------------------------------------- .. FINAL INSPECTION BY:_5-Date----- --- ~ 7 (�----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E9.9 REVISED 9.59 F.P.DO. Z.+ 6-60