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FOR OFFI EI"E: - 3 -- ---`~- ��-Y••--� ------------------------- APPLICATION FOR SANITATION PERMIT Permit No.I (Complete in Duplicate) Date Issued --------------------------------------- --------------- 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 +he work herein described. This application is made in compliance with County Ordinance No. 549. .� �' I s c _.-� . ---------- ------ JOB ADDRESS AND LOCATI�h, �--------- - •---------------------------------------------------------------•-•---------••-------------- /yy�---- Pho"._. ------------------------------- Owner's Name -------1f11► _, AddressIL ••--�-- -................... -- Mc� --•-•- Phone --------- --------------------- Contractor's Name pp -------• ------------•---------------- l '� 1 � Installation will serve: Residence ©,-Apartment House El Commercial ❑ Trailer Court (I Mote Other [3 Number of living units: __1____ Number of bedrooms ._�___ Number of baths ...-_ Lot size__d__1_.T-----------------••------•------- Water Supply: Public system �omSandi[]y system ❑ )Private [-]Depth to Water Table e___ ft. Character of soil to a depth of 3 feel t: SandGravel ❑ElElI Sandy Loam Clay Loam ❑ Clay Adobe�ardpan C] Previous Application Made: (If yes,date-------- ------ _____j No /New Construction: Yes R] --)4b ❑ FHA/VA: Yes [I No j} TYPE OF INSTALLATION AND SPECIFICATIONS: t1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / + i r Septic Tank: Distance from nearest well__ Distance from foundstion_%a______________Ma a _ I_.--__ I �___Size---1..3.10 ._._Liquid depth-- Capacity.--- �/ No. of compartments-______ :_._ 1 Distancefromfrom nearest welL_ : l:!h e Fi l d _ -Distance Distance from foundation_.,% I -___.-__.Distance to nearest lot line.._._____. Disposal Number of lines ---- I --------- I -- ----------------Length of each line --- .--V-/ --------------- Width oftrench ------ u�r_'!_r------------------ fType of filter material'�/�. &_' -------Depth 'of filter material___._' ............. Total length ---- .------ rte --•-------------_----- 1, Seepage Pit: Distance to nearest well ----- 1,. -_____________Distance from foundation. ------------------- Distance to nearest lot line ___._______._____ ❑ Number of pits------ ----------- I -Lining material -t ------- ------------Size: Diameter ---------------------- Depth -----------------••----•--------- Cesspool: Distance from neatest wellI------- _------- Distance from foundation -------------------- Lining material ---------------------- .._____________ ❑ Size: Diameter---- f --------- Depth-- I ----------------------------------------------Liquid Capacity --------------------------- •gals. Privy: Distance from nearest well.__:_______ ---------------------'---------------Distance from nearest building_______ ❑ Distance to neares}.lot line.-.-------------- -----------------------------•----------- ---------------------------- •---------------- [ --------------- Remodeling and/or repairing (describe)=-------------�---------------------------....------------•------------------- ----------•------ -•-----------------•-•---------------- ti , ---- ---------------------------- ----------------------------------------- II• ! _------------------•------------------------.._------•--------------------------------••-------------- ------------------- ------------------------------------------•-------------•---------------- ----- --..._ _ -------------------------------- P---1---------------------------------pI------------- -- ----------------------------•----------------- t i herebycertifythat I have re red this a lication ,a4that the'work will be done in accordance with San Joaquin County ordinances, State laws, and rul a regulati ns `he San Joaquin Loa{ Health District. (Signed) -• -------------- --------------------------------------(Owner and/or Contractor] --------•- ----- (Title)---------------------------- ---------------- ----------------- (Plot plan, showing o't, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1-----CP-X------------------------ - APPLICATION ACCEPTED BY ------ -�-'- ----------------------------------------------- DATE. I----------------------------------------- DATE ---•--------------------•-------------------------••--- ---- REVIEWED BY-------------------------------------------- ------------------------------------- ---I ----- --------------- ------------ , BUILDINGPERMIT ISSUED--------------- -------- ---- ----------- DATE------------------------------------------------------ -- --- Alterations ---------------------------------------- - - �>Q...•.-_ Alterations and or recommendations______ ___ _ _____�1--�nF�4..-----Ctrs-�.�--•----�-� '�-�----•••- rk--------•-------------•-----• ------ -------------------- ___________________ ___________________________ ____ __________________________________________________�j___...__-_--_' 1 ______________________ ____________________________ ____________________ _______________ ____-_.._____._______._.--------------------------------------- ____._-_-..___-__._______ FINAL INSPECTION -- --------- Date__... __'-- --_="------- -- ----- � • � + ti 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 E13-9 REVIOEo 2M 6.66