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FOR OFFICE USE: t - --- s�-;_,_t�"-t---l _-!(�� APPLICATION FOR SANITATION PERMIT Permit No. 1 -- ----- ----- -------------------- - -- -------------- [Complete in Duplicate) " " -This ,�t Expires 1 Year From Date Issued Date Issued ------------- Permit E..., -- , 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 C O 7-17 k_L- ---------------------------------------------- 7-------- Nam _ =: --•------------------•--------------------------------------------------- Phone---------•----------•-------------- Address ----/•-•i`-----_-----ti---------------------•------------•-••---------__------------ ----- -------------•- ------ -----•--•------------ Contractor s Name__-� 31._ J 1/ --------------•----------•------- Phone.........-------__-_-----•---•----- r, Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court }❑ Motel ❑ Other ❑ Number of living units: ...___ Number of bedrooms __ __ Number of baths Lot size ___-)T-...15t1ft-1 ----------------_............... _ Water Supply: Public system [Y-Community system ❑ Private ❑ Depth to Water Table Z;?�_ ft. Character of soil to a depth of 3 feet: #sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No M-- New Construction: Yes t No ❑ FHA/VA: Yes ❑ No 94— TYPE 4 -TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) s Septic ank: Distance from nearest well/lUO!•f_-___Distance from foundation_1p--------------Material_____ __ ___ __-__.__________________-____-_..... No. of compartments-----!�-n---------------Size----irfX--- Liquid depth---Z/-----------------Capacity -.--__- - Disposal Field: Distance from nearest well-'h0`6<...... Distance from foundation---1d_:_.........Distance to nearest lot line_.......... Number of lines---------'-----------!--------------Length of each line-------WO----------------Width of french-------- 5'.:!---------------- Type of filter material____- v '_____Depth of filter material-----��"............Total length---------A4 . -_----_-_-____.-_-- Seepage Pit: Distance to nearest well----_-----------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits---------------------Lining material-----------------------Size. Diameter-----------------------.Depth----------------•---------------- Cesspool: Distance from nearest well-----------------Distance from foundation----- ----_:____.Lining material----------------.____________________. ❑ Size: Diameter---------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals.N Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-___-__--___________________-------_ r ❑ Distance to nearest lot line.------- •--------------------- = -----------••-----------------------------------------------\�,� Remodeling and/or repairing (describe)--------------•--- ------, --------•=- -------------------------------------------------------- -------------:------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- > t ------------- -------------------- -------------------=-------------------------------------------- -----•-•----------—-- ---------------------- i I'hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules agrgullons of the San Joaquin Local Health District.(Signed)-------------------------------- --•---------- -------------- ------------------------------------------------------•------------------[Owner and/or Contractor] BY: --- - ------- - ---- [Title) 4 Plot Ian, showing size of lot, location of s st relation to wells, buildings, etc., can be placed on reverse side). [ P 9 Y FOR DEPARTMENT USE O LY I. 1 APPLICATION ACCEPTED BY--------------------------------------- ------------------ r 1 DATE-------------- r ---------------- REVIEWED BY------------------------ ---------------------------------•---------- --------------------- -----....------ --------- DATE-------------------- - -- - BUILDING PERMIT ISSUED------------------------------------------------------------- --...................................... DATE---------------------------------------------__------------- Alterations and/or recommendations:------------------ ------------------------------------------------- ------------------------------------------------------------------------------------ # 4 -•_'_'__—_`-------------------'--------------_--------------------------------------------------------------------------____•----------------•----•------------_..._..----------------------- -------- »....-------- ------------------------------------------- -•'-------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- ---------- Date--------- ---------------------+------ -•---- t SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street ]24 Sycamore Street k 205 West 9th Street } Stockton,California Lodi,California Manteca,California Tracy,California f r E8.9 REVISED e•59 F.P.80.SM 6.6D i