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FOR OFFICE USE: \ ___________---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No...%._�•. ----------------------- -------------------------------- (Complete in Duplicate) - ------ I This Permit Expires 1 Year From Date Issued Date Issued ---- 3.A 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___-..-_.__-- -------------------------------------•---•----••--•------------------------•-•-------- ------ Owner's Name_..` -------------- - Phone .......... --------- ._------------------------------ - s Address__JQ---- -------------------------------------------------------------------------------- ....................... Contractors Name• CSS{ L_t._S._.------•----•---------------•---------•---------------._...------Phone----.......---- - Installation will serve: Residence [Z[ --Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____!__ Number of bedrooms Z--- Number of baths --- Lot size ._' x_.LGti.--________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table Arlt. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------- ) No E!r New Construction: Yes [TTlo ❑ FHA/VA. Yes (] No Z4-- TYPE 4- -..TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] _- .�..�. _ a. Septic Tank: Distance from nearest well fA L .... Distance from foundation__/0_- __7.Ma'terial:__ No. of compartments___ y --------------- Size_._._ ,�_J--_--___Liquid depth ---�-'-__----------Capacity_8,Go- ..= Disposal Field: Distance from nearest well__----"`• --------- Distance from foundation__/,P.e7--* ' __Distance to nearest lot [ Number of lines---------/------------------------ Length of each line ... $'P- -------Width of trench____Z_f!"------ -------------- Type --------------__ -Type of filter material__'--- - 1j_a-1°_4_e__ Depth of filter material_.__ 18'_ ............ Total length -------- 8.d_ --- Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ........ .----------- Distance to nearest lot line ----------------- F1 Number of pits---------------------- Lining material ----------------- ------Size: Diameter------ ----- Depth ----------------------------- -... Cesspool: Distance from nearest well_________________ Distance from foundation -------------- ._--_.Lining material.. ------------------------------------ EI Size: Diameter ---------------------------- ---------- Depth ------------------------•--------------------------- Liquid Capacity ------------------------- •--gals. � Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building -------------------- ___----------_-. ❑ Distance to nearest lot line------------------------------------------------•-------- Remodeling and or repairing (d scribe :-----=---------------------------------------------- •---------- Y ------------- NG��sisC rfG C_. rem: s -•--------------------•------------------------------------------------------------ 1 -------------------------------------------------------------------•-------•---------------------------------------------------------- -----._...-•------------------------ --•------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed) s'---------•-------------------------------------------------------------------- -- -------------------------------(Owner and/or Contractor) IBy:-----------------------------------------------------------------------------------------------------------------------------------{Title)-------•---------------------------•--- -------------------. (Plot- plan, showing size of lot, location of system in relation to wells, buildings, etc:, can be placed on reverse side). �FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE ...... REVIEWEDBY --------------------------------------------- ------ DATE BUILDING PERMIT ISSUED ------ ----------- --�-----------------•----------------------------------- DATE. --------------•---- - Alterations and/or recommendatio s:--------------- ------------ ----------$1LD�------ARS----- ---1 � }N -�R0PF.R,'X -------- 5�?!ST m-------;6 8N---------5TR-�r u't`. N© •- hr1 HAVE-- -�.r- Ic_i��.7` CRNCa------ L --•--- I t L�'�L�?1.�-1. FINAL INSPECTION 'BY-------------------------------------------------------------- 1 1% O t ----- - � Date --------------------- 130 South American Street Stockton, California Ea -9 REVI9EO e.S9 i.P.00. 214 6.60 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street Lodi, California Manteca, California 205 West 9th Street Tracy, California