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FOR�OFFICE USE. _ ----------------------------------------------------- ------------- ------f---------------------------------------------_____________ ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...:/. .... {Complete in Duplicate) �� C - This Permit Expires 1 Year From Date Issued Date Issued ___._ _..._.._. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplicationis made in compliance with County Ordinance No. 549. E aTT=-CA - IOB ADDRETD LPCATION---61— g Nlkn ---Av ------s�2lM---PQ.$.K-_.__W...ON---5�:.- Owner's Name-----------jack........ �`a -- ------------------------------------------- Phone------------------------------------ Address............. r� ,,-rr r�_5C. 1/I.------..MANME: ----------------------------------------------•-•------.----------------------------•--- Contractor's Name---------- ..........'•---------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.__. Number of bedrooms [ __ ✓✓ ss,, _____ Number of baths �Lot size __ _��_____!�_____7Q�_.................. Water Supply: Public system ❑ Community sy m ❑ Private [Depth o Water Table _�- ft. Character of soil to a depth of 3 feet��Sand Gravel ❑ San Loam ❑ Clay Loam ❑ ay E3Adobe C] Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i" �� 5eptic�k: Distance from nearest well--- Distance from foundation._..lk7----------MateriaL.l .�_...-_-_�......................... No. of compartments---------- ---------Size__ x. _u_ .___Liquid depth______ ..._________Capacity..._ Q ._. ; Disposal Rid: Distance from nearest well---.42 ...Distance from foundation.....I - Distance to nearest lot line....-.S....--.... Number of lines-------____P�__1__________...Length of each line________ Q .Width of trench...__._. .._.__.____...__.. Type of filter material__._ - O_C_ `_Depth of filter material______ _ ________Total length____-----�--•-___________ ______ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-____-_.--_-_•_-_ ") ❑ Number of pits:.-------t----------Linirig material_•---__------•-----.-Size: Diameter-----------------------Depth-------------------•--------_---- � Cesspool: Distance from nearest well_______1________Distance from foundation--------------------Lining material--------- ........................... m El Size: Diameter------------------------r`-.�----.De th--..-----------.-------__--•------------------------Liquid Capacity............................gals. Privy: Distance from nearest well____ ______________________________ _______Distance from nearest building________________________-_._-________.._. ❑ Distance to nearest lot line. ----------•----- ---------- -•----•--•------....----....-.-•----------•---•----------------------------------------------------- ` I Remodeling and/or repairing (describe)----------________�_____ _ 1 -------------•-------------------------•---------- --------------------------------- ------------------------ } �'V%t4 A }S.),1 t �..` x ------------------------------------------------------------•----------------------- -- -------------------------•-- ..................•----•----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and r les and regulations of�the,San,Joaquin,Local Health District. (Signed)....... . .. . ....... --------------------------------------------------•------------------------------------------------(Owner and/or Contractor) B . .------•-•.....................•----............------..._..-•------•-•-----------------------------------------------------------(Title)------------------------------=---------------------------, .. - . (Plot pla , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). L FOR DEPARTMENT USE ONLY i.l►t1� APPLICATION ACCEPTED BY------- ------------------------------------------------------------------ DATE----------�` -!'7 --------- REVIEWEDBY----------------------------------------------------------------------------------------------------------•-•-....__.._...... DATE--------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------•--------•------------------------------------------ Alterations and/or recommendations:-------••----- -•- --------------------------------------•-----•-----------••------------------•---••-•-----••---------•---•---•----------------•-•-•--•--- .............•-----•-------------------------------•----- -----••-•----------------------------•----------------•-•----------------•-•-------•-••-------------------.--••---------------------........----------------•--- ------•----------------•--•------- • - -------------------------••---------•-------------------------------------------------------•----------- --------------------------•-•-•--•--------•--------•----------------•------ FINAL INSPECTION BY: b ---'-`--- -------------------------- Date------ ----------`==--- -------- --- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 7 REVISED S-39 2M 3-95I AILAS