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-- FOR OFFICE USE: -- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __J. .._:._ ° (Complete in Duplicate) W ----- - -- ------------- Date Issued _._. ...--- ---------------- __I'° ------,_----__ ,_____________-------------_----------- - This Permit Expires 1 Year From Date Issued ' A�, plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION-------`/`-------------LI-- I�r------ ---��---1-�------------------------•-----------------------------•----....-------------- ------------------ Owner's 'Name--------------------------------- 1e4?� _,CIIL"s-------- CJ-.�tN,$! _ --------- Phone__!? t•. 1 , Address-------------------------=------------------------------PR_q-9 ------V4,V./,='------------------• ----------------------------------••--------------------••------------------------•--- Contractors Name---------------- se-r Phone -------•------------ Installation will serve: Residence M Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ s - Number of living units: __/___ Number of bedrooms&___ Number of baths ____..-- Lot size ----- 'ari ___________ Water Supply: Public system ❑ Community system ❑ Private Imo' Depth to Water Table --v5-4t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PK Hardpan ❑ 52 Previous Application Made: (If yes,date___._______------__) No I4 New Constructiori: Yes ❑ No FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No,septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well_________________Distance from foundation_-.__.._---____.___.Material___________________.__-----. No. of compartments--------------------------Size------.-----------------.---s---Liquid de th-----------------.--------Capacity Disposal Fie ld: Distance from nearest well.____�`4-,..._.Distance from .foundation__'.�Q _.__.Distance +o nearest lot line_______,._.... l t .. •-- Number of lines___________________/.____.______Length of each lire_________-,5-.________.Width of trench---,------�____�_._______--_-_ Type of filter mafe'rial___ V&Depth offilter mA,erial__._' _:_._._Total length______________`tJ_ -_____._____-- Seepage Pit: Distance to nearest,well-----_---------------:Distance.from^'foundafion_'------------------Distance to nearest lot line--------------- ❑ -• 1 --- Number of pits --------=---------Lining material--- -------Size: Diameter—--------------------.Depth-------------------.------------- f a Cesspool- Distance from nearest well-----------------Distance from foundation__I----------------.Lining material________-__.__._____._.___-__ Size: Diameter.------- _--- ------------------ --- ------- --------Liquid Capacity ----------.-.. al.s- .❑ De th- Privy: \ Distance from nearest well___________________________________________ ___Distance from nearest building_____________________-__.____--__.___._- µ - ❑ ( Distance to noarest lot line - ------------ ----------------------------------•--------• -------- i y Remodeling and/or repairing (describe)-------------------- ----------------------------------•---------•------- = � t -------------------------•---------------------•---------7-------------------------------------------•------ -- T I �. --------------------------------•----------------------------------------------------------•--•----------•---•-•------•--------------------•-••--•------------ { c hereby certify that I have prepared 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. (Signed)- ---:-X-- �- } --------------------------- ----------------•- ------(Owner and/or Contractor) By:-------------------- -----------=---------=------------------------------- -------------------------------------------------I Iflel----------r----------- ---------------- -- ----------- (Plot plan;'showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FR DEP RTMENT USE ONLY ` APPLICATION ACCEPTED B --- --- -- ------ ------- ------------------------------------ - DATE " =a?1,` �/--•--•---------------------- REVIEWED BY - DATE rr BUILDINGPERMIT ISSUED-------------------------------------- '----------------------------------------------------------• DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------- -----------------=--------------•---------------•--•----------------� ....----•-----••-----•-•-------•-----------------------•-------- ------------------------------------------------------------------------------------------------------- ---------------•----------------- -------------------------------------------------------------------•--------------- -------------••--------------------- -----------------•------------------ ---------------------------------r----•----------------------------- ----•---•---------------------------•------ --------•---- -------------------------------- ----------------------------•------•-------•--}------- --- -- - ---------------------------- - ------------------------------------------------------------------------- -------------- --- .- 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 Lodi,California Manteca,California Tracy,California ES-9 RCVI9E0 9.59 r.P.CO.2M 6.60