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' FOR OFFICE USE: -- -----t-------------------- ---------------- r APPLICATION FOR SANITATION PERMIT Permit No. ------ -------------------------------------------------- (Complete in Duplicate) _, r -------.--- This Permit Expires f Year From Date Issued Date Issued8 .l Application is hereby made to the Sean 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 OCAT.O 1- �----_-- -•- - ------------------- Owner's Name-. '-•--------------•---- ---------------------------•--- •----•--- Phone------------------------------------ Address------------------ 1• `� s' � 6.Contractors Name---------';+ •.f�#'• - ----------------------------------------------------------------------- .... Phone--------.._.--------- Installation will serve: Residence;('Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: .- : Nt umber of bedrooms _-. -_ Number of baths,____ Lot,size g Water Supply: Public system 941' Community system ❑, Private ❑ Depth to Water Table io�ef Character of soil to a depfW of 3-feet: ,:Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan Ej Previous Application Madec'4'(Ifyes"date---------------______) No g3,-'New Construction: Yes ❑ No Zj- FHA/VA:Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is'available within 200 fee+.) No. of compaffments--------------------------Size--------------------------------Li Liquid de ,th----- ----Ca Capacity:•----------- ---- nearest well______________-Distance from foundation-------------------- __________:_ Septic Tan Distance from ne Material_______________"_--.--____ Disposal Field: Distance from nearest well------------------Distance from foundation -_-________p___-_.Distance to nearest lot line--------:_"_____ t y�f - / Number of lines_._I_________ _____________-__Length of each line________________- ------.___.Width of trench.___ __ V .Type of filter material----•--------------------Depth of filter material-----------------------Total length------------:___ :---------•-----------•- "Seepage Pit: Distance to nearest well_----------DistanceWm fo dation.. j ___ ___..Dist ce to nearest lot line/ ___-, ®� Number of pits.".f_____________Lining material._/ _Size: Diameter___ '-�.__.De __-"- ,I p . Cesspool: Distance from nearest well,-----------------Distance from foundation- __________..Lining material---------------------________________ [] Size: Diameter___: --------------------.__._ Depth - ____Liquid Capacity r - -gals' ------------ . Privy-' Distance from nearest well _______________ --------------------------------Distance from nearest building----------- __ ❑ -Distance to nearest=lot line--. - = modeling and/or repairing (describe)=-----'---- = -----= ----------••---- ---- t i �� - --•- ; ----------------'-------------`--=--------.- ----------- ------------------------------------- --------------- ------------------------------------------------------------ I here6y certify that I have'prepar'ed 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. E (Signed)_ r ------€----------------------- ----------------- By:--•-----------------------------�----------.--- -----------•-•. -`-'-r----------------(Title) -gAe,, ,--Contractor) t (Plot plan, showing size of lot, location`of syste relation to wells, buildings, etc., can be placed on reverse side). L `. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY °�' • -•-••••-•-••-•-- •"----------------• ------------------- DATE"---- =� REVIEWED BY. ------- '------------------- DATE--------_-----'-•:---------- - BUILDING PERMIT ISSUED----------------- =-----`•----_ ----------------- DATE---------------- ---------------------------------------- Alterations and/or recommendations--------------------------------------- - '' -------------------------------------------- t � , : ---•-----------------------------------------------------------''---------------------------------------------------- ------------------------ -- •--- ----:--------••---------------------------------------•-------- .1 - -------------------- -------- ------- FINAL INSPECTION ------------------ ---- Date `t - ' 1....------------------= ---------------------------- SAN JOAQUIN LOCALIHEALTH DISTRICT 130 South American Street 300 Wast Oak Slreet ' ' 1 144 Sycomoie Street 20S West 9th Street ,,. Stockton,California Codi,California Manteca,California Tracy,California 4 E13-9 REVISED 9.59 F.P.0 C.ZM 6.60