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FOR OFFICE USE: -------------------=----------------------------- q42— APPLICATION FOR SANITATION PERMIT Permit No. ......�'........... I ------------------------------------- ------ 2 0 —(0 l --------------------------------------------------------- (Complete in Duplicate) Date Issued `---r----------- --------------------------------------------------------- "" .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. rryy JOB ADDRESS AND LOCATION._._ rx- ------ xk---= Owner's Name----- _ 40. -- ------------------------------------- � -------------------------- ------ Phone------------------------------------ `fI -- - ------------------•----•--------------•-----------Address ----------- ------ Phone--------•--•-•-----=-------•------ Contractor's Name-------------�`�' �--•-•-••---...---------------------- -----------•---------------..:------•---- - Installation will serve: Residence [r'Apartment House ❑ Commercial ❑ Trailer.40I'Court ❑ Motel ❑ Other ❑ Number of living units: ---T- Number of bedrooms _7�__ Number of baths _1----Lot size -------•---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water`STable -%5-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[ Hardpan ❑ I - � Previous Application Made: (If yes,date--------------------) No ® New Construction:' Yes'[] No [9 FHA/VA. Yes El NO • R 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------------------------..__-----___.:_-___-_-_-. je No. of compartments------------- ------------Size.-------------------------------Liquid de th--------------------------Capacity--- •--•-r-- bisposa' Distance from nearest well.-__Distance from foundation--bg.... _Distance to nearest lot line__ t f{ Number of lines---------- - - ------Length of each line--------- - -- j�--X_-Width of trench---- ------------------- Type of-filter material t�Depth of filter material----1.8__.-__'�-Total length----------- ______________________ € SeepagePit: Distance to nearest'well_ ~P�-___Distance om foundation---7m-6'--------Di tans to nearest lot lin e---Oih------ Number of pits--_ _ _-'Lining material .Size: Diameter'_ ---------De th-.-_ -----. Cesspool: ' Distance from nearest well-----------------Dist~arice from foundation________________.__Lining material------------El -- Q Sizer Diameter------- I--------- -------------------Dep th-------------------------------------#-----------'` Liquid Capacity------------------------- -gals. -__--.__------- -----=-----------"= --''_:---Dstancelfrom4nearest building____..ti.__:_______________ _:.--- Privy: Distance from nearest well ----. ❑ Distance to nearest lot line------------------------------------------------------------------------�- _ 001, Re od and/or repaiti.ag escribe):_ ' --- = J/ IX - ` i ._-_-___ _________________________________________________________________________________________________________ _.___._ �'l I hereby certify that II have prepared;this�application and that the'work will e�done`in accordance with San Joaquin Coun�j,*; ,1 ordinances, State laws, and rules ana'regulations of the San Joaquin Local Health=District..•t � 3 (Owner aed�lea-�eOraeor) ( i4 $y----- ------------------------- -------- --------------------- .O SI ne _ ' "' ,, I 1 (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- --7 _��" -------------------------- "rare, DATE---------------------•----------------------------. ------- i - -=- - DA --------BUILDING PERMIT, ISSUED--------------------------------- Alterations and/or recornmendations------- ------------------ -----------' •-------------•--•--------- -------- -•---- ��• `� -- .. �s �--fit---�-�- � ---- - --- - - -- --------- ,� ---- - �---------.��_��---- w - _ _ -------------- ----------------- -------------- --- -- --- Y v.w- .. c ,----------------------------------------------------- --------------------------------------------------------------- l. FINAL INSPECTION BY:_ � _-rcrt!� i Date - 1� -- ==; a 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.4 li E¢•9 REVISED B-59 r.P.CO.1M 6.60 }