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FOR OFFICE USE: �!vf ---------- ZGC3 S APPL.ICATION FOR SANITATION PERMIT Permit No. .-..�_______________ ` ----------- ------------ ---------- -------------------------------------------------------- (Complete in Duplicate) x _ _.: ..- Date Issued ------------------------------------ This'Permit'Ekpires'l Year Fronm_Date' Issued Application is hereby made to the San'Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.-'' :3 ....k ---L JOB ADDRESS AND LOCATION_._.__.... 4-- Owner's Name------- s_ea_n.e_._... 6 F 71." Phone--------------_-------------•----- _I ----- Address ---------- F ._... -----------_...._ Contractor's Name__.'of....11F }� �� `� �� + � c - - Phone_ I �.. a Q- 1 Installation will serve: Residence Apartment.House ❑ Commercial E] Trailer Court ❑ Motel [] Other E] � Number of living units.._f._ Number of bedrooms Number of baths _ ._ Lot size ____fir __- _�_... .-_._-/______________ Water Supply: Public.system Commuriity'system ❑+ Private ❑ De_pth to Water Table-_ ft., as Character of soil to a.depth of 3.feet: 'Sand ❑ Gravel ❑Sandy Loam [I Clay Loam ❑ Clay ❑ AdobeOHardpan C1Previous Application Made: jif yes,date------------_____`__1. No K New Construction: Yes ❑ No�FHA/VA: Yes E]' No [ITYPE OF INSTALLATION AND SPECIFICATIONS: } ��r' "'��": 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from.nearest well. _ iIDistance from found tion._. Materia .. f r 'Size i. - No, of com a"rtmenits-.. Size. _+ Liquid depth__.ca�_. Capa ty... �J �, Disp I Field- Distance ftnz nearest well E�r(_ClDis#ance-frX 4-- room undation..f49__/'__...Distance to nearesrl.ot line..------_-_- ✓ c Number of lines___ _._.--_ --_ -_ Length of each lin4o----: __ Width of trench____ _ f Typof'fil a erial__ ,1{ '_:Depth of filter material-__`"/ _.___dotal length_._.._�9 '1:_j________________ _ ___Distance from foundation to nearest lot line__--.- __ _ ... Seepage Pit: `:Distance to rsearest well .N(_____ 3 ? y Number of pits------=#- g p {----------------=------ __..___.__Linin material .�o_r�_____._Size: Diameter__ ,. _..._ ''F-__De th_�" . _. 3i Cesspool' Distance from nearest well-----------------Distance from oundation---.-._____-------Lin g material_,._._ ,_.__.____._...._.__._____. Size: Diameter.l:--•---}---------- ---------Depth---------------------------------------------;- Capacity ------------------- Privy: Distance from nearest well ____ _ _ . ..Distance from nearest building_-__._._ __I___________. ❑ Distance to nearest lot Ime'° --- ----------------------------------- -------- _='-- ...._.°--------------- ----= -�Remodeiing and/or repairing [describe):---__-- -_- --------•--------- ---•---•------------- e_ .';. - -. -�,.� �.' t -----.-----------------------__ -• ------ -- ------------------ -- ,_ .' F Vr' E 1 ` ---- -------- ------ ---- ------ -------- -------- --- -. ------ -_.._ .-f---___-_---___-.--------------------------------------------. -_ I hereby certify-that I have- - prepared this- -____ application and that the work will be done in accord San Joaquin County ordinances, State laws, rules and.regulations of the San J uin Local Health Distric+. �_,P�... :R- (Signed)..................�y._ '_.X�6 �i �s[� �edn Contractor) SEPTIG TANK 56RVIC I �Y= gOr t::I�iinerJtve:;=: �'' f Title (Plot plan, showing size of lot�ldcation of system;+n-relatio o wells, buildin s, etc., can be placed on reverse side). '4 FOR DEPARTMENT USE ONLY APPLICATION ACCED BY `. ------------------- -----------= DATE-- `f �� ------------------ REVIEWEDBY---------- - ----- ' ---- DATE:---=---------------------------------- BUILDING'PERMIT IS5UED--------------------- --------------------- --------------------------'_--------------------I— DATE------------------------------------------------------------- Alterations and/or recom ndations: `. ---------------- °------ " = "= - -~--.-- --=•-•----=--------------••----=---------------------------------- ~ - Q �� -----_- ------ r ----------------------------------------------- --=-----------------------------------------•------------------------------------ -------------------- • --------------- -- ---------------------------------------- -------------------------------------------•---- --------------------------------------- - FINAL INSPECTION �~ SAN JOAQUIN LOCAL HEALTH C1jSTRICT� { 130 South American Street 300 West Oak Street 124"Sycamore Streets c_ 205 West 9th Street Stockton,California Lodi,California Manteca,California = ' Tracy,California CM-9 REWEED 13.59 F.P.CP•ZM 6.60