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FOR OFFICE U$E: _ - _-------------- APPLICATION FOR SANITATION PERMIT Permit No. �fJ �/_� `------------ -------------------------------------------- (Complete in Duplicate) Date Issued ..! T1 61 - -------------------------------------------------------- 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 Ordin e No. 549. ' JOB ADDRESS AND LO ATI ---- -------- --------- ----- + r. f - -----------•............................._-------------------------------------------•-----•- Owner's Name ---•- ---i-`--••-----•------------------- ---- -----------------------------------•--- Phone------------------------------------ Addres -------- ---- -S �ry--------------------------------------------------------------------------- ---------------------------•------------ Contractor's Name------- -- - -- -- -------------------------------------- --------------------------------_------------- Phone....-----_----.............. r Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units _- Number of bedrooms _�Y.... Number of baths Lot size .../ �-----------------------_-.._.__.._ Wafer Supply: Public system Community system ❑ Private epth to Water Table _79ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe& -Iardpan ❑ Previous Application Made: (if yes,date................___] No 9?"'New Construction: Yes ❑ No A' FHA/VA: Yes ❑ No [— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic TTar-ik: Distance from nearest well--------- ------Distance from foundation__-_--_.._.---..-_Material...._________.____..-........._.___._._-....-.. No. of compartments---------- - ----------Size------•---------------•---------Liquid depth---------- --------------Capacity----•------------------ Disposal Feld: Distance from nearest well------------------Distance from foundation--------............Distance to nearest lot line---_--_----._.... f9 Number of lines-----------------------------------Length,of each line_--------------------------------Width of +ranch----------------------------------- " m.. Type of filter material-_'---------------....__Depth of filter material-------.---------------Total length___....-.__...._:..__.__...._______..._-- Seepage Pit: Distance to nearest well--- -9_-_Distance fpm foundation_..A1®....--..D„',s�nce to neparest lot li '._; • Number of pits._-_-Z__------ in maferial. ---Lin . je Size: Diameter_- ii Cesspool: Distance from nearest.well---- ---------Distance from foundation-------------------.Lining material--------- _._--.-__----_---__-----. a ❑ Size: Diameter--------------------------------------Depth-----------------------•'---------------------------Liquid Capacity----------------------------gals. t Priv.y: Distance from nearest well-------------------------------------------------Distance from ,nearest building = Distance fo nearest lot line-----___------------------______... `Remodeling and/or repairing (describe-):.-;'..-:-_ -___l V -- -----------•---------------------------------------------------•-•-----•---•----------------------------•------. --------------------- -----------------------------------------------------•------------------------ • , ------------------------------•-------•------------- ------------•-------------------------------------------•----••-•----------------------------------------------•------------------------------- --- ------------ I hereby certify f6f I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a Aru 4andgLilafions of the San'Joequin'Local Health District. (Signed) •----- ------- -- ., ---------------------- �or Contractor) # l , Aie�_ � - (Plot plan, showing size of lot. location of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------------ -_.. = -=a DATE DATE DATE.-- ------- ------ ---- ,B -U ------------- ---------------REVIEWED BY_ . Alferations and/or recommendations:.--------_----------------_______ I - -------•-•--- -------•------------------------------------------------------------------`------------------------------------------------- ....---- -------------•--••- •--•---•----- I 1 1 5 ---------------------------------1----------------------- FINAL INSPECTION BY----------------------•----------------- ----------------� _ Date_----------d--------- -----` SAN JOAQUIN'LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street , 205 West 9th Street Stockton,California Lodi,California Man feca„Califarriia T.racy,.California ES-9 REVISED 5.79 r.P.60.7M 6.60 I