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f� f -- ---�1__ APPLICATION FOR SANITATION PERMIT Permit No. .__(_. ---------------- ---------- ------------- --------------- (Complete in Duplicate] 5` - - ----------- ------------------------------------ --- 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. 4 5# -- -----------•------------- - e�4.4 Owner's Name----W--:77: Address-----1-'Z,0 Contractor's Name------Q-�N_�1�_-----•---•_----••-------------•- ---••--------•---------------- -•-------- Phone Installation will serve: Residence ® Apartment House I] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L--- Number of bedrooms _-3__ Number of baths ---i---- Lot size Water Supply: Public system ® Community,_.system ❑ Private ❑ Depth to Water Table S-A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EL Hardpan ❑ ' Previous Application Made: [If yes,dctte--------------------) 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.) Septic Tank: Distance from nearest weif___AQy"te_-Distance from foundation----10!_-----"Material__r_� ® No. of compartments--------- --Size-3..'-x- � �` Liquid depth l R Capacity !- : r Disposal Field: Distance from nearest well--- ,o__t��_Distance from foundation....7-:Z-�-......Distance to nearest lot line------- ® Number of lines-----5---------------------------Length of.each line-3_Q3_Fz0' (QQ'--Width of french---- 4_"____-_____ ___ r` E Type of filter mate rial �r r�"�k,---------Depth of filter material------ t............ r--------------------- Seepage -" -- "V Total length------•1-5--4---•--•----------- eepage Pit: Distance to noarest weft-.-Wr>vl-l-------Distance-from foundation----1_Q_Q-........Distance to nearest lot line---._S_!.---_ Z Number of pits-----Z-------------Lining material__"'o —------Size: Diameter__A'_�._I4? ""-- Depth------�5_`----------------------- f Cesspool: Distance from nearest well---------------- foundation.-----_-----------.Lining material---------.--------------- El Size: Diameter--------------------------------------Depth-------------------- ------------------------------Liquid Capacity--------------•-------------gals. Privy: Distance from nearest well----------------------------- .--_---.-Distance from nearest b0clin El Distance to nearest lot line---- -------------" `' Remodeling and/or repairing (describe)------------------------------------ --- ----------------------------------------------------------••----•---------•-------------•------------------------------------------------------•---•------------•----•-----_- ----------------------------------- 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) -------------------- -----------------------------------------(Owner and/or Contractor) BY: -- ------ - Title _ ------------------------------ 4_-_ (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------j�!%__,_ .s_ -------------- DATE--- -- .�- --5__.._-----..- IEWEDBY------ -----------------•-----------------------------= -----_---- --- -----------.- DATE BUILDING PERMIT ISSUED----------•----------------------------------- ----------------- -----. DATE. :.. Alterations and/or recommendations:--___"----.---_---""-_._ -- c.. ----------- --- ----- ` ------------- FINAL INSPECTION BY:.----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Ee•9 REVISED e•59 F.P.Gp.SM 6.6p