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FOR OFFICE USE •- ------_ -__- '/ -: .. j APPLICATION EOR SANITATION PERMIT Permit No. .................. .... / ---- - -- m Date Issued --------------------------- ----------------------- (Complete Duplicate] ---------------------1_ --Vii.__.___-_---____- This Permit Expires 1 Year From Date Issued f Applica ion 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 Ordinance No. 549 JOB ADDRESS AND LOCATION----- --- -----a'� = ` J,- Q .L� --- Owner's Name------------- -- - / � . _ 1- l ' 1� `n Phone Address------------•---------------------•---I..8___d_ •--- ---------• ---------------------------•-----------------------------•---•-.....-.....------•------•---------•-••----------- Contractor's Name---------------------- - --•- t �-'-`^� ------------------ ------------------------------.. Phone------------------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial 2 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--j__. Number of bedrooms ___i__ Number of baths .1----- Lot size ----- ___6: >� ------. ---------------- Water Supply: Public system ❑ 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 ardpan ❑ ; Previous Application Made: (If yes,date____________________) No M--"'New Construction: Yes ❑ No 9A/VA: Yes ❑ No ['f}�'-' TYPE OF INSTALLATION AND SPECIFICATIONS: Septic (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p c Tank: Distance from nearest w II_�+_-----___.Distance from foundation___,,le___�_____-Me rial_P_�J. ___ v. No. of compartments__ ________________Size_ `_�__,, ,�4 Liquid depth____.�%„ ,,,.___Capacity__r ______ isposal �Id: Distance from nearest well.:__,----Distance from foundation___��'..._......Distance to nearest lot line�_/_______ UV) ©/ Number of lines_____________/_________._____---Length of each line______~ _ f________-Width of tren&l .. -___�� Type of filter material_ Id-!f7_�__Depth of filter material__:_j ................ otal length------ Seepage Distance to nearest w1____/_&V________Distance from foundation_l..rt.j_____.Distance to nearest lot Gne__4.......... Number of pits----------------------Lining material___1C_Q_c.._4e...Size: Diameter_ -------__..Depthr2-tS-_/________._________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----_-_----------.____________:____k.. ❑ Size: Diameter---------------------:----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------- __Distance from nearest building ❑ Distance to nearest lot line-----------------------------------------------••-------------------- ----------------------------------------------------------------- :-I r 1 Remodeling and/or repairing (describe):---------------•��r�-��-•-_.�'�--�-'�� -�- '-G------•---- - - --�•----•-••--------------------•--F 15 --- ----------------- -- _ -------------a --------------- -- r....�..�- - - ----------- ------------------------------------=--- ----------•---_-- ------- = i yi r�r I hereby certify that 1 have prepared this application and that the work will'`lie done in accordance with San Joaquin County - - ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ISi ned ----- 9 ] Bd A Q �j-----(Owner and/or ontractor) Br•------------------ ---------- -- {rtlel------{.. ---- [Plot plan, showing size of [oKr ocation of sy tem in relation to wells, buildings,eTc., can be placed on reverse side]. ' FOR'DEPARTMENT USE OPILY APPLICATION ACCEPTED BY----- ---------- Y-7 --- ------------------------- DATE.------- '��. =----- REVIEWED BY----------------------------------------------- �. ------------------------------------ DATE-----••- - ------- BUILDINGPERMIT ISSUED.......... ------------•-------------------------------------------------•-------------------------- DATE---------------------------------------------------------€---- Altera#' n and/or r commendatio --------•---- -----••-•-------------------------------------------------------- --------------------- E_-- -------- -= — - = 4 s ___________ ___ _____________ ______________________ ------ _ -----_ .______.__--.__-------------------------------------------------_Y____.______._.__.._____________._____-_---_---_._-_-._____-__--.- _ ./.-- - '�-} Q-ff= - - -----...--'------�---`-`e`�-----��` Z•2�---------- -------'`- ---- r U f FINAL INSPECTION BY---------- --- ---5,./ ------------------------ Date---------------------- -----"y ----------- 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 f E6.9 Rrv16ED a-59 F,P.CO.ZM 6.60 �� F