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FOR OFFICE U E1 Permit No. - --------------------- ----- - _-_ _�-d-__--•--- APPLICATION FOR SANITATION PERMIT � --: -•- �• •• --------------------------------------------- --------------------------------- -------------------- {Complete in Duplicate) /� 3/ �. _--------------------- --------____.__. This Permit Expires 1 Year From Date Issued Date Issued ------ ------ 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 LOCATION-----1.5~Gyo Q�d ��ty, r o •-- Owner's Name_.___& C=------K, -----------------------•----•-----------------___------------==- --------------------------------_. Phone Address------------- xrs�..... r -- ---•-•------ ----------------------------------------------------------------------- :... --------------------- Contractor's Name--•- -_ - ------ --- ----•--------- -- - ----------------------•-------- Phone..__... Installation will serve: Residence ®!Rpartment House ❑ Commercial E] Trailer Court El 1.2- ❑ Other [3 Number of living units: ---ri____ Number of bedrooms s --- Number of baths --- --- Lot size _. X �a�------------------------ --------- ► d. ft. Water Supply: Public system [VCo-mmuriity system ❑ Private ❑ Depth to Water Table _ Character of soil to a depth of 3 feet: r Sand,❑, .Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ❑—Hardpan ❑ � Previous Application Made: (If yes,date----------- -----) No pa' New Construction: Yes glNo ❑ FHA/VA: Yes ❑ No U�--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer_is_available within 200 feet.) „ p Size foundation Material - '1 Se Tank No. of compartments- well_______________D--nee from ---------Liquid depth---------------- `--___Capacity-_____.-__________._--- " pis sal Fi ld Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line.---------------- ; ier of lines.-_ 1 Leng..h•'of,eaeh line Width of trench. Tlype of filter material__________________ _ ;D<pth of filter_,M ., length------------------------------------- . Seepage Pit: Distance to nearest wellf�a_______________Disfanceifrom foundation��___........Distance to nearest lot line________--- Number of pits.-J-1-1---- materiai__it_0-- ---_.__-Size: Diameter_!�3_'_._.__._____Depth_-_ �_�________.________-- --� F l • •�. � Cesspool: Distance from nearest " well_________________Distance'from foundation--------------._ Lining material_ ____________-__---_. Liquid Capacity------------•---------------ga1s. El Size! Diameter--- --------------------------------Depth-�--------------•-- ----• C Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____--__-_________--_________-__--_------ ❑ Distance to nearest lot line------------------------ ------•-------... ------------------------•--------•--------------•-------------- ! � qi ---•----•------------------------------------------------ �j VJ Remodeling and/or repairing (describe):-----t:./�'�_--�-- � I - ------------•-----------------------------=----• ---------------------- ---------------------------------------------•-------------------- -------___--•------ - ---------------------•---------------------------------- i :. -- -- - ------- -• ---=--•--------------------=---------------- -- ------------------------------------------------------------•---•--•-------------------------------- I hereby certify that I have prepared this application a d 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. (Signed) - ------------------------------------ -----------•----------------------------------------- (Owner and/or Contra ------------------------------------------------------- --------------------------------------------------- - Title-------- [Plot plan, showing size of lot, location o system in relation to wells, buildngs, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- c DATE -----•--------- ------- r,��- REVIEWED BY f EDATE__-f�.• )" �'`� BUILDINGPERMIT ISSUED---------••-•--=----------------------------{'----------------------------j---------•------------ DATE_---------------------------------------•----------•--------- Alterations-and/or recommendations:---------------------- --- .,�.�:--••---------=;------------------------------•----------------------------•--••------------------------------ - ---••-------------••--------•--------------•----------- _------------------ -_ S Q -''3 - -------- f I r7 FINAL INSPECTION BY:----------- Date------ ---------•-•---------------------------------------------------•-------- -- -- -- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California di.041,California `Manteca,C aria Tracy,California Ee•fl REYI6 CO 8-59 r.P.0 0.-2-6.60 C• � ,�� }