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rUKUF-l-K-t LWOL: ,s --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... ----- {Complete in Duplicate)-------------------- ------------- ------------- Date issued ------------ -------� -------------------------------------------------=------- 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 described. This application is made in compliance with County Ordinan a No. 549. �j h J08 ADDRESS AND LO TION_ _ _ _ "_� ! _ l / L { Owners Name... = "-..._ ...... Phone---------------------- Address x� - ------- ---------- --------••---------------------------------------------------------------------------- Contractor's Name---- ------------- /I�L4''ll .-----------r--------------------------------------..-__ Phone -- ----------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ p Number of living units: I--- Number of bedrooms S. Number of baths Lot size ------------------------------- _. Water Supply: Public system ❑ Community system 2-1-private ❑ Depth to Water Table ---�Af. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adoberdpan ❑ Previous Application Made: (if yes,date-------______-------) No ® New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep�tic,/Tank: Distance from nearest we I____�--�-_____Distance from foupdation____/Q__/_.Material_4_w��f'F -------------------- -------- /�� ._______.._. LK No. of compartments__„�________________!!Sizes��_�kSA�(,?Ligdid deptk�____- �._ Ca aci l. _¢ ._. Disposal Field: Distance from nearest wej I --- -------._Distance from foundation._f3 .l�D��i��,ff''ct nearest lot Number of lines Length of each line_ ________��_____.WEc�4h 'french___,Z_ _-_________________ It Type of filter material, fAZAGDepth of filter material____`�----------Total length____,, B,0__!___________________ Seepa Pit: Distance to nearest well------- �'_--------Distance�fr m fo dation___.4p_ .___.Distance to nearest lot line----e°�__-�- � Number of pits-__._____________Lining material. .Size. Diameter- ��----------Depth-_,,,&- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------.-------------- -.Size:-Diameter------------ -____- --_—.Size:-Diameter----------- rDepti-F--------------------------------------------------Liquid Capacity----------------------------gals. C Privy: Distance from nearest well--------------------------------------------------Distance fr6m nearest building------------------------.________._._____- ❑ Distance to nearest lot line=---------•---•----------------------- ------------ ---- --------------•---------------•----------------------------------------- ?r Remodeling and/or repairing (describe):-------------=- -----------------------------------------------------------------------------------------------------------------•--------------------------------------------- -------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin County ordinances, State laws, and rules and regylateons of the S n Joaquin Local Health District. (Signed]-------------------- ----------------- ------------(Q�Contractor) ------- (Plot ---- --------------------- B 1------------------------------------------ 'f--------- Title)- (Signed) e- / f.-mfr ' (Plot plan, showing size of lot, location of system in a on fo weNs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------------- --____ DATE----____-- "-------- REVIEWEDBY,------ •----------------•----•----- -------------------------------------------------------------------/--------------------- DATE---------------------------------- BUILDINGPERMIT ISSUED_---------------------------------------------------•-•---•-------------------- ••-------•--- DATE---------------------------------------- Alterations and/or recommendations-------------------------- -------------------- ----------------------------------------------------------------------------•------------•--------------------- ------------------• --------------------------------------------------- ------------ --------------------------------------------------•----••-------•------------------------------•--------------------------------------- ----------------------------------------------------•--- -----------------------•-----------------------------------------------------------------•_.-......---------------••----------------------------------------------- -----•------------------------------ ---f--�-'-�-� r {fes*---------- - --- ---------------------- FINAL INSPECTION BY:--------------- ---- - Date----------- - r`�-` ------------•----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CA-9 ArviorD 0.69 F.P.co.1M 6-60