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FOR OFFICE USE: -------------- ----------------------------------------- - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___��61.6 -------------------------- i-- ------------------------ (Complete in Duplicate) Date Issued 7 -------------------____ ______________________________ 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 nc No. 549. /0 9? x'0 ,,` _ JOB ADDRESS AND LOCATIONA tZ-- ?��,-�P-----•-- --•- ---• -1 - - -- ------ -- --- Owner's Name----;-'7 = �Y-- r Phone...l7� .- 3T _t Address / ---------- - � � -----------------•- / 1 t -s-� Contractor's -•-----••-----------------------------------------------------•--------.-•-----.----••--•-------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial. Trailer Court ❑ Motel El Other [INumber of living units: _— _. Number of bedrooms -------- NumlSer o "Flaks -------- Lot size .__� U.�X.r .Q'. .......................... Water Supply: Public system ❑ Community system ❑ Private [A Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 10 Hardpan ❑ Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - D .ry --•------. -—--------------- DoTank: Distance from nearest weiL�Q._'�_.•Dis#anc from�undBa�ion_� MaleriaI __ __ _____'�" ___ DoNo. of compartments____a4-___.____j____.Size..,�L _- _r ___. _/._.Liquid ep?h___#_Y�__..________Capacity___�_____�______ Disposal Field: Distance from nearest well. G1-- __Distance from foundation..j�_ Distance to nearest lot line__s _______ T-- --- � Number of lines------- __________Length of each line_______7�__ rr._._.Width of trench______ -.-/ Type of filter materia '�'_ p p De th of filter material------ -- ------------ length-------7`_��--------------------------- s� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-._______.___-_ [] Number of pits----------------------Lining material----------------------.Size: Diameter------------------ ----Dept h--------------................... Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material------..____-_.._._.____........ ❑ Size: Diameter--------------------------------------Depth----------------------------------- ----------------Liquid Capacity............................ Privy: Distance from nearest well------------------------------------------------- from nearest building__________________________________' ❑ Distance to nearest lot line----- -----•--------- ----------------------------------------------------------------------------------------------------------------------- Remode ing d/or repairing (clesgibea '': - -� _ /� ------7 __ t_ _.____�__ _____________________________________________________________________________________________________________________ ------------------•--------------------------•-------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- -------------------------------------------•----------------------....-------------------- ------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,�Slaws, and rules and regulations of the San Joaquin Local Health District. (Signed)- ----------- !.e----I`-1 t1-- (Owner and/or Contractor) e------ _.= ----- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY------ - - ------�'--�,,�i�'`z• --------- - --•-C_ ,A DATE-------- _z 7_�-�--C�_______------ REVIEWEDBY--------------------------------- --------------------------------------- DATE------------•------------------------------------------•-_- BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE-.------•-•--------------------------------------------� Alterations and/or recommen .#tons:--------------------- w ------- -- I ----`" .. � f`7' +cert•-�.�---. --.`/ -----•-------------•----------------------------------------------------------------------------------------------------- `-•- -------•-------------• ------------------------------------------------------------- -----•----------------------------------------•---------------------------------------------------------------•--•------•---------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_ --•------•---__ -• Date_.vZ__-- _ ��..._______.- 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 ES-9 REVISED B-59 F.P.00.ZM B-50