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FOR OFFICE USE: G ---------------------------= -- 7v__ ot APPLICATION FOR SANITATION PERMIT Permit No. ...1 --------------------------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date fssued Application is hereby made to the San Joaquin Local Healfh 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 L/OCAT]ON__ _�_3 -_ _...r--------- ------------------------------------------------•------------------------------------------ Owner's Name__ A.�i. - i--•----------•-•-------------•----- Phone --------------------------------- -- ------------------------------------ P------------------------------------------ _.-- - -- 4� ----•---------------••-----••-•------------------------• .-----...---•------•................----------�.j. Contractor's Name. " •-•--•- = +_ �. ....... ---- --------------------- Phone Installation will serve: (Residence [A—Apartment House El' Commercial ❑ 'Trailer-Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _2 __ Number of baths _1.____ Lot size ---lr_4,A_M6________________________________ Water Supply: Public system gr—community system ❑ Private ❑ Depth to Water Table-_ ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?—Hardpan ❑ i Previous Application Made: (If yes,dote--------------------) No me" New Construction: Yes INo ❑ FHA/VA: Yes ❑ No qL-- TYPE OF INSTALLATION AND SPECIFICATIONS: " ; G (No septic tank or cesspool permitted if public sewer°is available within 200 feet.) Septic Tank: Distance from nearest well-1+7ke.___Distance from foundation-l-4____________Material--------IL:a______________p_-_____.._________ 91. No. of compartments-------�L--------------Size...... -±�S' - ----:_..Liquid depth-------tl.'_-------------Capacity.-R-�a 4 x1" -- Disposal Field: Distance from nearlest well _ Distance from foundation. .........Distance to nearest lot line.4.....__....I Number of lines----4------------(-----------------Length of each line----------?Or.............Width of trench----------- s!."------------- Type of filter mate'rial__"';IS'li_4�. y_____Depth.ofzflter material-------- .8'.`-------Total length-------------- Seepage Pit: Distance to nearest well_!Y_re+v�_______Distance from foundation___�Q..---------.Distance to nearest lot line.-A!r-------- Number of pits__________.___._____Lining material'.i__ aif_�----Size- Diameter______ _ p Cesspool: Distance from nearest well ___-•_-_______-_Distance efrom foundation___ --_-______.__.Lining material_____________________________________ Size: Diameter--------------------------------------Depth--------7!!r_.r4-------------.--------------------Liquid Capacity gals. rk Privy: Distance from nearest well______________________________________ f_._Distance;from nearest building_________ __.____________________._---_-. ❑ Distance to nearest lot line--------------------------------------•------------------ ---------------------•------------------------------------- ( Remodelingand/or repairing (describe)----------------------------------- -------------• ------------------i-------------------------.----------•-•--•------------------------------------ r ------- ------- a--------------------..------------------- ----------------------------------------------•--------------------------•---------------------------------------------- ••---------------- I 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 ru:ocation Esystem f the San Joaquin`Local Health District. Si ned 1 ( 9 �------...--•-----•---�--•- -------- -- -- >} - ---------------------------------(Owner and/or Contractor) By: =-- - ------ ------------- ------- -- (Title) (Plot plan, showing site of lot, relation to wells, buildings, etc., can be pieced on reverse side). FOR PEPARTMENT USE ONLY APPLICATION ACCEPTED i3 ---------------- .......-•.................. DATE------ :.-------.._...---- ----------- REVIEWED BY---.----- I -- ----------------------------- ----------------------- ....... DATE------ BUILDINGPERMIT ISSUED---------------•--------------------------------------------•-------j--------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------- -------------------- ---------------I----------------------------{---------•-•---•-----------------------.....---•--------------------------- 1 r ------ t ! —�:: I -- � - ----•-- -----------•------- ------------------- ----__----• ----------------------•--.-.._._... ------------------------------------- ------ - -- - - - - 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 Ea-9 REV,6E6 a-59 F.P.CM.^.M 6.60