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�. 012 OFF USE: r �= !--------------------- --------------- ----------------------------------------- (, PplICATION FOR SANITATION PERMIT Permit ------------------------------------------------ -------- (Complete in Duplicate) / ------------------------ _____________________________ This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549. OCATION..._.L% � �� Owner s Name______ J .__ Phane. 8- kS JOB ADDRESS AND Address......: t�--•-- n r� ----- .. - - e ------------ Contractor s Name_____ _._ ..___ �` _ __ Phone Installation will serve: Residence'[-] Apartment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other• WZV4 , Number of living units- -------- Number of bedrooms ________ Number of baths ________ Lot size ------------------ =______.,--..___.__„_._--_________--..__ Water Supply: Public system [I Community system ❑ Private Q Depth to Water_Table .--I__ ft. ,. Character of soil to a__depth.4of 3,_feet;_Send EQ -Gra -I )]"' Sandy Loam `Clay Loam DClay E] Adobe C] Hardpan E] Previous Application Made: (If yes,date-----------_--------) No�g New Construction: Yes No E] FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATION$: t q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i - i r Dd Septic Tank: Distance from nearest well___570___ -Distance"from fc undation2.1_G-:._______.Material_____ ® No. of comparlEe`nTe-rits < Size__K" 1 _.__L-iquid depth----- -------- ------Capacity.. QD , Disposal Field: Distance from nearest weH�_$��_=i:_.Distan to from foundatiorli4V_!.4 _'.Distance to nearest lot line....::. ....... T e of filter materia] : -_ �"+*Lengh ,,.of each line-! `+t,-s__ TS-".Width of trench_-_.'24__,__._________________ Number of lines________ _ . � _ ___________Len the �t. yP s _ � p of filter material---- �� Total length �� ar st well_____________"______.;bistan}e from foundation--------------------Distance to nearest lot line----------------- Seepage Pit: Distance to ne m ❑ Numbed of pits"-_._ yLining�:�nateri8l-----------------------Size: Diameter------:-.-----'---------Depth--'------------ •--------------. i Cesspool: Distance{from nearest well_____.___:------Distance from foundation--------------------Lining material----____---------------..-.___-______ I Size: Diameter' .� � ---------'--------Depth----------------------------------------- ----------Liquid Capacity. -------gal Privy: * +b.istance*from;nearestrwell__h .__,__._.__�___'1----._____,%_,_-_D.istance'from nearest building___________________-___"___________--_.-. ------------ -- Distance`Fo nearest.lot line'' ''" :_ Remodel in and .or''re airin (describe)-----.- - •.---s..� +3iZ-------------•-------------------------•-----------------------------------------...._.--------- " �.,4 ____g.i- /, 0 p 9 i `y. .�►** sat C -------------------------------------------- ------ ------------------- ------ 4 = '-------------•-----------"--.....---•--------•----------•-•-----------•=-- I -- I------------------------- --------------";_------------------------------------------------------------------ I hereby certify that I haveprepared Ais application and that the work will be done in accordance with San, Joaquin County ordinances, State laws, and rules And egulattons 61'Ltlie"5eR Joaquin Local Health District. ($igned) --r----------------- Owner and/or Contractor) I sY' --- --- -------- ---- --•----- - -- - ------------=-----------------------------------------------•----(Tit e--------•----- - ------ (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -t ---= = DATE C7 t R-EVIEWED BY------------------------------------ ` = DATE..-• ( BUILDING PERMIT ISSUED-----------------•------------------------------F------------—--------`--i------------------------- DATE------------------------------------------------------------ Alterations -----•---------------------------------------------Altera tonsand/or recommendations, �.c.y{{{{;;;• ! recomm enda`t�ions - - � __ "__y.. ._'__..._ ------: - __-."" r ' e ----------_-----------------------------------------------------------___1_-_--------------_-------------_----------.._--------------------------------- ._. �.- J } --------_------_---------------------------.----._._.___-__..______..__--....__._..____-_._______._._.._."_._____.__-._"_...____._--__--.---_-_____.___-__._-_-_.______.__.____________.._.__. FINAL INSPECTION BY: -------- -------------------- •--------- Date---- SAN JOAQUIN LOCAL HEALTH DIS RICT 130 South American Street 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Locil,California Manteca,California Tracy,California .a - C9-9 REVIe EO 8-E4 F.P.0 O.-2fA-6�6C1