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FOR OFFI -E USE: ✓ � �— �__ - �-- APPLICATION FOR SANITATION PERMIT Permit No. -2 ---f V�_ ----- -- - ---- ----- - -- --- - --- - (Complete in Duplicate) ( r = kf Issued This Permit Expires 1 Year From Date Issued Date _____,_. :_____ 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 +CATION r -------- •-------•----------------------------------- �� Owner's Name------ -- -•-•---' ------------- Phone---.-------------•-- Address = 2 - ------------------ ----- Contractor's Name-------------------------- +� . ... - •------------=---- = Phone Installation will serve: Residence ®partment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ Number of living units: -__l_ Number of bedrooms _-_ __ Number of baths ___ Lot size ../_� d.. �4-�_--_________________________ Water. Supply: Public system Fr Community system El Private [_1 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [3Clay C] Adobe E3-Hardpan ❑ ' Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS; , (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) ep is Tank: Distance from nearest well_________________Distance from foundation................ _Material_ __.._____________________________.__________-- 1No. of com artments__________________________$ize.. ...._________ ---- Li Liquid depth.__. .Ca Capacity ------ --------- ill-It is' I Field: Distance from nearest well-------------_.-Distance from foundation--------------------Distance to nearest lot line-----.___.____-_. a Number of lines-----------------------------------Length of each line--------------------------..--.Width of french-------------:---------------__---- Type of filter-materiai-------------------------Depth -of filter material-----------------------Total length------------------------------------------ Distance to nearest well -----__Distance m fo ndation_.�0._._-___.Distance to nearest lot line;__+ _.___.." (A3 i Number of pits___.___S -----------Lini g•maferial.-. ¢ Size: Diameter---3_�-------------Depth___ _ _______________ "V Cesspool: Distance from-nearest well-----------------Distance from foundation-------------------- _____- Lining material------------. . .--- _.-__-_..___ ❑ Size: Diameter:-------------------------------------De th_--_.----------------------__-=--------------=------Liquid Capacity-------------------------_--gals. Privy: Distance from nearest well___.________'..__:__-_______________________Distance from nearest building--------------------------______._______- " ❑ Distance to nearest-lot line---------------- ----------------------------------=------------------------------------------------------------------- '--------------- l r Remodeling and/or repairing (describe)= --------------------- --------•-------- -------------------------------------------•------------------------------------------------------ i ------- - -------- -------------- E r � ------- -------------- - t --------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- I hereby rti y that Fhave pr-epared this application and that the work will be done in accordance with San Joaquin County ordinances, t aws, anti ules and regulations of the San Joaquin Local Health District. GL✓�/� Owner and/or Contractor {Signed) ---------- / } ----- -------- ----- (Title}_- -- F (Plat plan, showing size of lot, location of system in rel ton to wells, buildings, etc., can be placedon reverse side). �3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------------------------------------- DATE----- I - - =--� ----- '--------------- REVIEWEDBY -------------------------------------- ------------------------------------ DATE-------------------------------------------- -•------------ BUILDINGPERMIT ISSUED------------------------------------•--------------------------:---------------- ----------------• DATE---------------------- ----- -- --------------- Alterations and/or recommend ations:_._1_D_--c-AF-1-------------I s�`---�- -fi. ----•'----- - _--... - -----�-Qf .....�:�. I i -------•------------------------------------------_•----- --•---------------------------------------------------------------------------------•---_..-•-----.•-----•------------------------------------------------------- -----•----------------------------••----------------------•---------------------------•-------------------------------------•----•-----------------------------------------------"----------------------------------------- -------------------------•----------------- .............................. -•---------------- ------...............-------•-------------------•-•---------------------------------•---------------------------------------- i FINAL INSPECTION BY;.___-�Z ----------------- -- •-------- Date.3-O----is--- ki-k---------------------- w - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Led[,California Manteca,California Tracy,California E5-9 REVISEC 0.59 r'.P.CO.9M 6.60 C