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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... ._•--•--.....-- /y ------------------- {Complete in Duplicate)------ ----------•--------------- --- Date Issued ---�-----../L_.. ---------------------_-_---------------------------.--- 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.% I J JOB ADDRESS AND LOCATION -------------------------� --_f'K�w)--�h� �� s-�._.. lam. Owner's Name 1 f 0-------------------------------------------- Phone-- Address.. � . Contractor's Name-------------- ----....---------------------------------- Phone-•------•----------------••----•- --------------------- ---•---- installation will serve: Residence'0 Apartme House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms ._7 -• Number of baths _A____ Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ __ ft. Character of soil to a dep+hof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ i Previous Application Made: (If yes,date____________________) No 94-11 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.) Septic.Tank: '`' Distance from nearest well_________________Distance from foundation----------- Material_..---------------------------------------------- ° o. of compartments--------------------------Size---------------------------------Liquid i!? de..pith_____:`------------------Capacity........... Pisposal Field: Distance from nearest well__- .Q___.._Distance from foundation.___. iDistance to nearest lot Field: ��7 Number of lines__�rr__I_______________ Length of each line_-.1�Q_n________-width of trench----2-- ---_------...__ Type of filter material._-�-t-�epth of filter material_2Q_ ---------Total length____/a A9_________________________ eepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_.__._._.._..._.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------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 rewiring (describe):___-- -- _ -.- --• --••--w--.__.Let. 'f—� .P_ ,-f _ �—# � ' _.�c.. --------------•------------ ---------------------- ... ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- 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 rules and r gulations of the San Joaquin Local Health District. Si ned . __-___________________ ____________. Owner and/or Contractor By: � _ _ (Plot plan, showing size of lot, loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ REVIEWED BY--------------------------------------------------------------- - --------------------------- DATE----'.7...• l BUILDING PERMIT ISSUED — ------------ -------------------- DATE---------------------------------------r--------_.r_p-��----------- Alterations and/or recommendations------------------------- -- ------------- - - ------------------------------••----•------------------..:'---------------------------------- ----------------------------------------------------------------------------- ----•-------• -•--------------------•-•----••------ •-------•--,_...._....._......_._ ...........-------------------------------------- -------- ---------------------------- FINAL INSPECTION" BY:.------ Date = -`. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 324 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 69-9 REVieEO 8.59 F.P.CO.3M 6.60