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FOR OFFIC . � ' ; ---- - ,��- } 'APPLICATION FOR SANITATION PERMIT Permit No. ..�1__ _a_: l : ------------------------------ ------ !. (Complete in Duplicate} . _ .�-: Date issued --------ll_J--lF/_ --------------------- ------------------------------------- ". This .Permit Expires ] 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 No"549. JOB ADDRESS AND y�LOCATION__----_---- ----__�!l�� .c---------------------------- ---- Owner's.Name------�!�!�t.: l- ------- �1`` 7 e ----------------•------------------ Phone.-.-----------------------------• i Address...------••-�15-._ !'f••-------•-----•-----------•----------- --------• ................ .........-------••-•------------------------•-•-__-----------------------_-....... k Contractor .....t's Name._..- -----•_.....---....�..-------•----------------- ----------------•---------------------------- Phone----------------•--.........------- Installation will serve: Residence ❑ -Apartment House ❑ Commercial ❑ Trailer Court E�Motel ❑ Other ❑ INumber of living.units: ________ Number of bedrooms -------- Number of baths ________ Lot size ---------_______________________---------------------------- Water.-Supply: ___________________________Water. Supply: Public system' 92-60mmuriity system ❑ Private ❑ Depth to Water-Table-,4- ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam ❑ Clay Loam ❑ Clay Ea Adobe ®'Hardpan E]_ r . Previous Application Made: (If yes;date--------------------) No El"' New Construction: Yes O'No ❑ FHA/VA: Yes ❑ No E7_ ' R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarek: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------....... Q No. of compartments--------------------------Size_--------------•----------- ---Liquid depth--------------------------Capacity---------------------- �� DiDisposal Field: Distance from nearest well-�� _._Distance from foundation....................Distance to nearest lot Iine.S. ..____. Number ofJines ____________�__________________Length of each line.------------------- of french--------- ' Type of filter .material__�4c.4-_------__Depth of filter material_,, ------------Total length..........3_> _---------_--------- Seepage Pit: Distance to nearest well--ctw-_-____--Distance from foundation--------------------Distance to nearest lot line_`----_--________ E� Number of pits-l-:----I-----------Lining material-__'_R .C./f----Size: Diameter--- ----------Depth-------.r'L ..-----------• r Cesspool:" Distance from nearest well-----------------Distance from foundation--------------._----Lining material__-________-.______-_______---------- . ❑l" Size: Diameter---�---------------------------------Depth------------------------------------- -------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________________________-___-_____. ❑ _.,, -- Distance to nearest lot line------------------------------------------------------------------------ � - i Remodeling and/or repairing (descr�ibe): -u�_..�_ � _ ... �._ __-_ _ _.__ __�...��li!!-'�'4�..._..6______ ___ __________ ---------- �` 1----- - `�� - �r ` ° {r-•-----•------------------•--------------------------- ---------------=---------=-------------------------------------------------------------- - -------•- � I I hereby certify that l have'prepared=this application and that the work will be done in accordance with San Joaquin County ; ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed) '-- ----------- ----- --------- " -----------------------------------------------------------------------(Owner and/or Contractor)' By: ------------ -.•-`- -' ----------- --------- ---------- ------•---------------------------------------(Title)------------------------------------------- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 3 FOR DEPARTMENT USE ONLY r APPLICATION-ACCEPTED BY--- '�-J ------------------------------- DATE----- --------------•-------------- REVIEWEDBY =-----------------------------------------------•-----------•---•-----• ---•-----•--•---- DATE.....................................................- BUILDING=PERMIT ISSUED-------------71-------------------------------------------------------------------------.............. DATE---------------------------------------. ------------------ Alterationsand/or recommendations:------------------ -------- `-------- --------------------------------------------------------- -----------------_--.----•-------•----------------••-••••----•-- I �a � y' = r� �� ' -------•---•--•------- l - -----------------------------`------------- --------- •- -- I _ ._r.. ....... -71 "t^-` FINAL INSPECTION BY:.. Date - _-1 ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT�� 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street r7� Stockton,California lodir California Manteca,California Tracy,California �� 2 E9.9 REVI.EM - .�