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FOR OFFICE USE: ,� AP ,L 3,v3 -�L `ow I APPLICATION FOR SANITATIO PERMIT Permit No. ....>.>._... (Complete in Duplicate) .S l 3 >o --------------------------"-_--__.._..__:_.--_-_.___.__- This Permit Expires 1 Year From D04 Issued Date Issued ------- ---------------- ----------- -------• Application is hereby made to the San Joaquin Local Healfh Dsstrict for a permit to construct and install the work herein described. This application 1s made 1n compliance with County Ordinance !No. 549. JOB ADDRESS AND LOCATION----....... --_•... =• -- ........................ Owner's Name -u_ "":. 1 :--•-------------------- Phone..................................... Address........-I ---7-:c�'--�:....::�-=------� --'�-=-'.`-� �-'----------------------------------------•-----------...------•----....-.•----------------....------------�--•----------- w, . Contractor's Name de� !f-U?' -..... ° ------•--------------•-•----------------------- .... .... Phone.......... Installation will serve:, Residence EK"Xpartment House ❑ Commercial ❑ Trailer Court. ❑ Motel [3 Other ❑ Number of living units:;-°ll---_ mbar.:of bedrooms ._.�3 Number of baths :__�._. Lot size ..__- __lam_-. .(=• -- -_----_--••-••--•- Water Supply: Public 'system Community system C] Private [I Depth to Water Table _,5f�ft. Character,of,sail to a.depth.of,Meet:_Sand E]-Gravel,❑ Sandy,Loam.❑ aClay>Loam ❑, ,Clayy❑ Adobe 0- Hardpan ❑ Previous Application Made: .(if yes!date__4A&Ixf=1 No 0 New-Construction: Yes Er-No ❑ FHA/VA: Yes ❑ No -r�+•T1fPE'�F INSTAti4.AT10N AND'SPECIFICATIONS: (No septic tarlk•or cesspoolfipermifted if pu.6lic Sevier is as vailable within 200 feet.) i Septic Tank: ,Distance from.nearest well--- Distance from foundation-------- ----------Material'. ................................... ii I i ❑ of compartments.. ------ --�^------Size:.._.-.---� -----------'=_•-•-Liquid depth---------------- f, -------------- CppacitY �' Disposal Field: ` istance9from nearestwell__ stance from jbundation____I-rf___________Distance to nearest lot line................. . Number-of-Imes :_ x 777.1Length of each .line__1.x3�-__ _l_�Cl4a�+1/idth of trench _ _.`�_______.......... 1 Type of filter material b.e''IL---Depth of .filter material______1.c/--'__.__Total length3_f�,_ _____________ i r t (� Seepage Pit: Distance to nearest well,_-_I_____.__._"-__Distance from foundation.......___----------Distance to nearest lot line__-_____.__...... 1 ❑ ,-,%mbar of pits-------; --- -- Lining material--------_- ""'Size:'Diameter----------------- ----Depth-. --------------=--------------- p # Distance from foundation___-----------------Lining material_:__________._._._____________...... Cess❑ool:�" v Size: D'a ete nearest well-- ------- ----Depth-------------------------------------------:---------Liquid Capacity_---------------�•------gals. -, Privy:•'- .....w ;�,�,•�.Distance from nearest .well------=----- ----------------------------------Distance from nearest buildin g---•---------------•---..-t...----------- - xDistance to nearest lot line------------------------------------------------ --•-_--------..........------------------•---•-------------------------------------------- Remodeling •--•----•-------4--------------Remodeling and/or repairing (describe)----------------------- -----•-------------------------•-•---------•------------;----=-"=--------•----- ---------•-•---•_--....__..................... " II I! k -- ..............................- --- ---------------------•-- ....----------•----------------------------••----•-------------•-••-------------------„ _ --""----•----- --_--------------•---------•-•------------- ------•--•---•------------------------•-.-------------•-•--------•_--.....---------------•----------•---- ------•---- __----------------------------- ---------------------------,R 1 t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State'laws, and rules and regulations of the'San Joaquin Local Health District. (Signed)________________ _ _(Owner and/or Contractor] } .... = ------------------------ (Plot ----••----•--------- ---------------etc. ca{bele}laced on reverse side). (Plot plan, showing size of lot, location d sy to relation to wells, buildings, p ] t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ----- -----= '------------------------•-•-•----------- DATE...S. -•---2—--------_------------ REVIEWEDBY-------------------------------=.c----------- ------------------------------------•--------------------------------------•- DATE---------- -------------•---------------•---------•--••---- BUILDINGPERMIT ISSUED------.... ---------------------------------.-------------------------------- DATE------------ ---------------------------------------------- Atterafions and/or reco��M e dations: ^----- - ------------------- F----------------------------- �5 -------" '-�¢ -- -- -c4 ,� f ps f ' .-<s q �.-.. . ...__ E . ------ --------- ---� - r .. -- = - ------ .. ------e-=- .r !. -•::• -------------------^..._...-----------..C�. Cf`'-'-r--4 ---E------ "--y� r- ------- --------•--------------....--------•---.-_-------------..._..--.•-- ..............--•-••----•------}--------------- e (/ I t �`� y FINAL INSPECTION BY:---- ----�'��-- Date__.., ----- --------------------- --------- ------------------------------------------------ ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srrset 144 Sycamore Street 405 West 9th Street Stockton,California ? Lodi,California Manteca,California Tracy,California ES 9 REVISED B-89 ZM 5-61 Ar LAS !•i”'-�„