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FOR OFFICE USE: ------------------------------------- •;. APPLICATION FOR SANITATION PERMIT Permit No. .... �_3__.I: .... -----------------'-----------' ---------------- -------- ,., - -- -E- (Complete---: ,-- (Clete in Duplicate) .- - -- .-;= :� ,�: - - Date Issued --------------�-�,! ----------------------------------------- ------- -_----------------- ---'--:--! ." 3 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 descrlibecf. ' This application is made-in compliance with County Ordinance-+4o, 5549. JOB ADDRESS AND ATION.....:4...--- 4e---- -- ------- - --- _ Phone...... tltlI Owner's Name..:. = -- -- --------- -----_---•ul------- Address----------•- - • •-- ---------------- "--------- ------- --- Contractor's Name--•--=-------• / -----------------------••---•---._. Phon :..�-��-- t G Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' �A • I f ' Number of living units: Number of bedrooms Number'of baths __/_ Lot size ___/ _- �� f-------•-----I�---•••- Water Supply: Publidsystem, Commuriit_yw system ❑ T Private E] Depth.to Water Tablee/4-- ft. q!I Character of soil to a depth of 3 feet: Sand E] Gravel ❑m Sandy Loam E].' Clhy Loam [I Clay E] Adobe Hardp� n ❑ Previous Application Made: (If yes,date---.----- ._-_-.---) No ❑ New Constructi _ on:-Yes ❑ No. ®l""FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer,is available within 200 feet.) i e is k: Distance from nearest well-----------------Distance from foundation-------__-----_---Material---------------------------..----------- --------- No. of eom artments------------•-------------Size------(---------------------•---Liquid depth---------------- ---------Capacity-----------..��hh�-------- Isp sa Fie Distance from nearest well------------------Distance' from foundation--------_------------Distance to nearest lot line__---.�----_.____ I I 4Number;of lines-------------------------`----------Length fof each line------------------------------Width of trench.-----------•-.-•-------��--------- +V Type offilter material-------------------------Depth of filter material.----------_----------- otal length-------..._________.__.________----------- . Seepage it: Distance to nearest well__-_ kJC —___-Distanc' Tfoundaflo tion___ __-------D'stpncto nearest lot line---�LC_ p Number'of pits-"---` ------------Lining materi -- _ ize: Diameter__.-� E,___--..--.De th__.__�0511 Cesspool: Distance from nearest well_________________Dist n..-_-,_-._- _-_-.- Lining material-_-....-..--__-___-----.- a-.-. ❑ Size: Diameter--------•-----------------------------Depth--------------------- --------=------ ------Liquid Capacity--------------•--------�- gats. Privy:i Distance from nearest well------.------------------------------------------Distance from nearest building_-___.-__-_-----_-.---_-_---_��-.-_.._. ` ❑ Distance to nearest lot line----------------------------------------------------------------------- ---•-•------•---------------------.-----------....--------------------0---- ---- ' I---------- Remodeling and/or repairing (describe)-----------------------------------------------------------------.--------------------••---------- ` = ------------------------------------------------------------------------------------------I--------------I----------- ilp--------- } -- ------------------------------------------------------------------------------------- -'`--------------------------------------------------------=---- I hereby certify that I have.'prepared this app ical tion and that the work will be done in accordance with San Joaquin County w ordinances, St laws, and r sand regulati -IS of the San Joaquin Local Health District. ;,(Signed)----- --------------•--•-- -L-,- --------------------------------------- ;z -r :; �_ wrier and/or Cont actor) �--- ' Title t �. By--------=-------------- _ ��.� ---- - ------ (Title)1------------- ----- --------------_-- ------- -- 'y plan, showing size of to , location of system in rel ion to wells, build ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY IIIIII APPLICATION ACCEPTED BY . . �i� C ------------- DATE-----9/,,? (c1.L_--------------II---------- REVIEWED BY-------------------- ----------•------------- �---------------------------------------------------------- 10DATE �� BUILDING PERMIT ISSUED-------------------------- ----------- DAT Alte -bns an /or recommendations-------------------------------------------- - ---=---------------••------------------------------••-•---•- •--••------------------------------------------ F -----------------------• -- - = ------------'� - ------ --------•-----------• -------- -------------------------••------------------- ---------------------- - - -------- • -- -- ----------------------------------- ------------------------- --------------------------------- FINAL INSPECTION f3 .-------- --- pate . rl SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 124 Sycamore Street' 205 West 91h Street Stockton,California lodl,California rT-Monl4ca,tCalifornia r Tracy,California I E6-9 REVISED 6.39 F.P.00.ZM 6-60