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�FOR-OFFICE-OSE: -------------- ----------------------------- mit No. _..t 3 J c., APPLICATION FOR SANITATION PERMIT Per ..................... .20 (Complete in Duplicate) In------{e ---- Date Issued ----- -- This'Permit Expires"I 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 Ordinance VD. 549 - ---------------------------------- JOB ADDRESS AND LOCATJ!01 N--- - •............. Owner's Name--- -----------------_--------------- Phone /Address-....... x - ------------------------------------------------------------------------------------------------;........ -------------------- ------------------------------------------- Phone..,..------------_--------------- Contractor's Name.------- -- - -- - -- ----------- Installation will serve: Residence Apartment House [3 Commercial E] Trailer Court E] Motel I-] Other El Number of living units: Number of bedroom'SJ_ Number of baths _Z__ Lot size ---------_------------------ Water Supply; Public system W. Community system El Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam El Clay Loam E] Clay El Adobe 9[�dpan 11 Previous Application Made: (if yes,date------ -------------) No P"---New Construction: Yes 2No ❑ FHA/VA: Yes KI—No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool_permitted if public sewer is available within 20,0 feet.) Septic Tank: Distance fro' m nearest well------—-------Distance Irom foundation----A9 ----Material---- �No. of compartments.... ...................Si., 4_0�9_!!�Liq,icl depth--- - ----------Capacity_ Distance from nearest well line-_-4�� Disposal Field: ------- Distance from founclatipp---0_!-�-a------------Distance to nearest lot lin Number of lir rench__.�,-----------_w-------------- Length of each line---7J_7e�--------_.Width of t Is p -------Total length .00 Ty�e of filter material th of filter material---le!!� ------------------- Seepage Pit: Distance to nearest7well---------—---------Distance f found ation___Z49__ jD' t-qn �---ce to nearest lot line_Aw� ----- . , 4 14N Number of pits----A-_----------Lining riiaferialsize: Diamete �.---Depth--- --------- Cesspool: Distance from nearest well_......... -- . -------------------Lining material.-_.--.-_.--------.----_--.._..-_.-. ................Distance from foundation El Size:..Diamefer----------------------------7--------Depth- ----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---_---. -----_----------------------Distance from nearest building---.-------_-----_----__---__-.-_-_--.--.- El -'Dis ta-nce't&nearest lot line------------------ ----------------•--------------.._..------------••-•-----•--------0 --- ---------------------- ------------------------------------ Remodeling an or re firing -- ----- -- -------e__�-------------- ------------ ---I�n_-E_ • -.. fo - ---------------------------------------t-------------------- ------------------------------------------------ ---------------------------------------------------------------------------------------------------------------- I W i - .. ----------------- ---------------------------------------------------------------------------------------------------------------------------A----------------------------------------- ------------------- ---------I'hereby certify-that I have-prepared this application and'thaf 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)----------------- ---- --- -------- -------ec---------------------------------------------------- /or Contractor) --- ................ . By:---------------------- ---------------------------------------- --- - - - --------------- -----------(Tif le)--, ... (Plot plan, showing size 0 of lot, location of systeetin relation placed to wells, buildings, etc., can be 'laced on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- -------- - --------------------- DATE--------- ---------------------- ---------------------------------------------------------- REVIEWED BY.--------...------------------------------ -- ---------------------------------------------------------------------- ------------- DATE BUILDINGPERMIT ISSUED------------------- --------------- ------------------ ----- - - ---- ----------------- ------- ------------------ Alterations and/or recommendations:-- ----------------------------------------------------------------------- ---------------------------- -------------------------------------------------------------------------------------------------------------- ------ -----------------------------------------------------------------------------------------:----------------------------------------------------------------------------------------------------------------------------------- ---------------- -----------------------------------=•-------•--•--------•----------- ---------------------- ------------------------------I--------------- ----------------------------------------------- --------------------- --- ------------ ------------------ ----------- ------------------------------------------...... ------------------------------------ ----------------------------------------------- FINAL INSPECTION 'BDate-------- --- ---------------------------------- Y_�_ -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cafffornia Lodi,California Manteca,California Tracy,California ES-S REVISED 0-69 F.P.00.2M 6-60