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]-UKGt-FI E USE: ------ r f--..-----:-: "-. APPLICATION FOR SANITATION PERMIT Permit No. ..f��J_�--� ---------------------------------------- -- (Complete in Duplicate) -------- --- This Permit Expires 1 Year From Date Issued Date Issued ... v Application is hereby made to the San Joaquin Local Heal+h 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 � gTIO -----------• 1� -------------�-j-- -------- Owner's Name----- --- - . _ -- ------ -. •-------------_Phone_7. W'�� _.J Address.................... --•--------------•--�- Contractor's Name_.-.X&- •-- - - ] - . ----------------- ---_--. Phon % ./; - _ Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ * er of bedrooms -------- Number of baths ______- Lot size Water Supply: Public system ❑ Community system ❑ Private jDepth to Water Ta6le.351__ tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel [3 Sandy Loam ❑ Clay Loam [] Clay ❑ dobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: C(No septic tank or cesspool permitted if public sewer is available within 200 feet.) c� Distance from nearest well_________________Distance from foundation____--__________-_.Material ___._________...______.........____..._......._.. No. of compartments---------------------------Size...------------------........___Liquid depth--------------------------Capacity I o dd. Distance from nearest well______--_______Distance from foundation........_-----------Distance to nearest lot line.____.........:: Number of lines------------------------------------Length of each line------_---------_----------..Width of french-----...___=_..:..------•-••_-__-• Type of filter material--------------------- ---Depth of filter material------------------.�--Total length___-._---____------.._•_--.--_-__r_ -- See a e Pit: 'Distance to neares well_l '�....-...Distance from f.undation_I X.__-,Distance to nearest lot line__._.... Number of pits___, _ g p Al F � _ ____.._____Linin materlaL__lG4-.____Size: Diameter_.__.�-�....-,Dept>�_D.-.�--.�a("'--•_- Cesspool: Distance from nearest well_________________Distance from foundation---.-.--------------Lining material---------------____.....__ 6\ 171 Size: Diameter--------------------------------------Depth-------------------------------- -------------------Liquid Capacity C� Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------_-- 0 Distance to nearest lot'iine--------- = - Remodeling and/or repairing (describe)______________________ . ...-•----------•----------------•-----••---••--•---•---- R ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and egulations of the San Joaquin Local ;Healt'histrict. (Signed��'L. .... .. � �� +-� /...., �•�.¢ ------------------------------------ Contractor) 7 By:......................................................------------------------------------ {Title} I (Plot plan, showing size of lot, location of system in relation ells, buildings, a ., c n be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- -------------------------------------------- DATE--- .� `-------------- -------------------- ------------------------------------- + REVIEWED BY. -------------------•-----------------------•---------------- DATE..--------- BUILDING PERMIT ISSUED-- - �P .. ::: - _ - '- i.....-:.._�� C",,, Alter io s and or re ommendations:-_ _ ^'"'" --�� ------- -- -- --tet-- ..............'--„�,�..._..... --- --------•- - ------- ........... ----- -- ------ -- - -------- .— _... FINAL INSPECTION BY: /.... -_....:-� -------------------------------- Date---------_.�_o/:f” s—r_ l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 west Oak Street 124 Sycamore Street 205 West 9th street i Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8.99 RM 5-61 Ai LAI