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FOR OFFICE USE: `-------------=----------------------------------- >r J (a ±,___ APPLICATION FOR SANITATION PERMIT Permit NO. ........................ ---------------------------- ------------------------------------ ----- --'---------- (Complete in Duplicate) 3 - 4 ---. ..... =--- --------------------------------- -_- -- 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 Orclirla.ceAP., 549.,., 706 ADDRESS AND LOCATI Owner's Name,,- - 6op ?1e __ - ------------ - 4-- -- ------ Phone------------------------- ` , Address �r ......•-----. Contractor's Name--•------------------ ----------------------------------- -•--------------•-------------- ------•------ Phone................------_----------- Installation will serve: Residence, 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel- ❑ Other [I Number of living units: _j__ Number of bedrooms 41_ Number of baths -> Lot size ___ -. . ............... ... '` t"?-.--.--- Water Supply: Public system E] Community system ❑ Private [�epth to Water Table ofd ft Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,-date------------ -----} No New Construction: Yes J�<No ❑ FHA/VA: Yes ❑ No 94r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , eptic T nk: Distance from nearest weII�Q:�Distance fro�rT[] foundation---Zd---------.M`,��eriai_- p-------------- -1 No, of compartments =-- -___ +.--Siz :�C_r" 6t-c> Liquid idepth_? - -� .-----.-__.Capdcltyl� O i Disposal Field: Distance from nearest well -- - DistS"nye'tr9 foundation----4( _..-_---.D�i ance to nearest lot line.-- Number of lines _" - - 04- . Length of each line�� - Nidth of trench-- --------------------------� �N Type of filter material- _41 -Depth of filter material--_ --- -- Seepage Pit: Distance fo nearest well---------------_---_-Distance from foundation.....I-------------bistance to nearest lot line---._---_-__----. ❑ Number of pits------- ,Lining material---------------- -----Size: Diameter-.- ......Dept h----------------.--.------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------,------e----:Lining material-------------------------------------- El Diameter--------------------------------------Depth ------------ ------ ---------#Liquid Capacity----------------------------gals. Privy: Distance from nearest well ----------- ----.--_-----_--Distance from nearest building----.--.---_--_.-_------__----.---.-----_. ❑ Distance to nearest lot like-----T- .� -- ----------------•------------------------------------ Remodeling and/or repairing (describe :- F, ; ---• - --- = ---- - -- --------- ------------------------------------------- --- ---- --------------------------•--•------ --- = � ------t---- ;-- ------•--, ----•----- - ------....-------------------------------- - - --- =-- - - ------ ----j------------------'----•-----• !.�------------ ----------------- ----------••---------------`------------------------------------------- I hereby certify that I have prepared th'is'application and that-+he work will be clone id"a'"C ordance with San Joaquin County ordinances, State laws, and rules ano7egulationsof the n Joaquin,Local Health District. f f . i (Signed) Contract - - -- -- Title---- -- (Plot plan, showing size of lot, location of system in relat' to ells, buildings, etc., can be placed on reverse side). FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.------------------------ -- - - �, -- -------•-- DATE-----------•----•---------� ----------------- ---------- REVIEWEDBY----------- _0 -- --------------------- ------------- DATE------------�' ---• -----------------••- BUILDINGPERMIT ISSUED- -----------------------------------------=---------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations-------- -------------------------------------- ------------------------•--•-------=----------------•----------------------------------------------------------- t --------- -------------------•---- - ------------------ -- -- - ------- - t 11 FINAL INSPECT Date------------- 11 ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street y 300 West Oak Streeti 124 Sycamore Street } 205 West 9th Street Stockton,California Lodi,California J J Mbnteca,California Tracy,California E9-9 REVISED 6.59 F.P.Co.2- 6-66 4