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FOR OFFICE USE: `LL -_ _______________�-;___--_- APPLICATION 'FUR SANITATION N PERMIT Permit No. f.t?..r1........... --------- S:IGC C l + 'ri=p w N This Permit Ex Tres 1 Year From date-6sued �} ---- ( omp e e r uplica+e} V ....._. �...: - I ".. -a-Date issued ! t Application is her-aby.made totheSan Joaquin'Local Heal+h District for a permit o onstrucf install the wooterein described. This application-is-,'made•iri�compliance- ounty Ordinance-No:-549:-- } t JO$ ADDRESSAND TION------ - ------- = Owner's Name`------ I i 6 _ - --------------- Phone------------------------------------ Address--------•`- . ......_ { Contractors Name_:---- •- :!. ---•-------=--=------------------------------------------------------------------------------- ------------- --------------•-- --'------_.-•-.__ Phone----=-- 7 Jcz Installation will serve: Resiiidance Apartment House ❑ Commercial"❑ Trailer Court ❑ Motel ❑ Other ❑ ;1.11�. x Number of living unr�r f�-^- Number,,of bedrooms 449-.-Number of baths�- Lot size -___-Z � ___________________Water Supply: Public Sys�m ❑l Community system ❑ Private [��epth to Water Table .. _..-. ft. Character of soil to a dept�li o 3'fee+:, SandG�eveE T Sandy Loam ❑`Clay Loam v Clay ❑ Adobe �lardpan ❑ Previous Application Made. (If yes,date---f - ❑-1� No New Consft�uctioF—-Yes'�No ❑ PHA/VA: Yes ❑ No [" "TYPE.OF•INSTALLATION-AND SPECIFICATIONS: a f i y (No.:septic tank or hesspool permitted if'public sewer.is available within NO feet..) Ce�jt�ic�Ta ) Distance from nearest wall_________________Distance from foundation-__-_-_..__-______-Material--------------------------------- --_-__________- No. ofpcompartments Size------------------------•--•----Liquid de�tyh_.... -= Capacity................. Di a Distant from nearest well.+ _ &stance from, foundation-_ p__l_-___Distance to nearest lof Iine__�____--- N.umbep of-lines=----.:�a!-- jdength of each line----a. �_ Y__�_ Width of trench. ----------------------- Type o� filter maters -f_ epth of filter material./ ._�� Total 'length__. . --- '- iW Seepage Pit: Distance to nearest well---'______.__._ ___Distance from foundation----_____-----------Distance to nearest lot line___________-___-- ' ❑ Number of,pits----------------------Lining- material------=-- g�. .)..Size: Diameter------------- -----.Depth------------------------------- Cesspool: Distance from nearest well____-._-__-.E__-Distance from#foundation--------------------Lining material__.__________._____.____-__-_....-.. ❑ Size: Dtiarrieter----------=---------------------------Depth-----:---------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well______________:__-_-___--_________---------------Distance from nearest,building-__--_-___._________-_---_-____.___��._.� ❑ �,. Distance to nearest lot'line."-'-----'-----__ -- -------------------------------•-___.----- Remodeling ands/or repairg (descrilje.}:------------------ ----------------------------------------------•---•----•------------------------------------------ \ ----------•---------------------------------- ---------------------•----•--- -------------------------------- ----------------- - - - :k - I hereby certify +hat I"have pre a a 'plic tion and 4hat,thewtirk will be done in accordance with San Joaquin County ordinances, State favus, anI rut regulafi s Joaquin Local Health District. 5i ned 1 �� __ I ( 9 )-----•- ---- -------- -- •=II�-- -- - -- ------'------ ---- --- --' ------------------------------------------------- ----- -- --•----'--------- ---Owner and/or Contractor By:----------------------------- N ---------------- --------------------------------------------------------------_-------------------(Title}-t-------- ---------•---•-- --------------._ ---------------- (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 APPLICATION ACCEPTED BY------. ___-DATE----------------- _4 REVIEWED .__________ - REVIEWED BY--------------------11111 -----... ... ... DATE---•-----------------1--------0---- BUILDING PERMIT ISSUED----------- --------------- --------------------------------------_--------•--•-------------------- DATE------- A Alterations and/or recommlendations:-------------:----------------- -------------------------------------•-•----••----•--------------------•-------------------------------------- ------------------- -----------•-------------�I-------------------------------- --- --------------------------------------------- ---------•-- -------------------------------------------•------ ---------- ------------------------------------------------------------------------------------------------------.-----------------------------•---------- ' ---------------'-------------------------- ll�-----------------------------------------------•-------------- ...._..._ FINAL INSPECTION BY:---L'-%--._.Tbrl. L;.s----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i : Lodir California Manteca,California Tracy,California EB-0 REVi13ED 13.59 F.P.=2M 6-60 I * 4 G