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FROFFPE)J� 9. ----------------------------- - -------2`--3,J-JA APPLICATION FOR SANITATION PERMIT Permit No. ... . Y G� (Complete in Duplicate) s`�, .. --- ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued •----1.._.1.V. --��---�---- 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 male in compliance with County Ordinance No. 5 9. JOB ADDRESS AND L C_A_ TI ON _- s ----------------------------------------------...--- -------. ---....-------••--•-.....--•--- Owner's --------------Name- ------------------------------------------------------------ --- Phone._..-......... ----------------- Address ----------- Contractor's -- ----- Contractor's Name__ a --•----------------------•-----------=.......................... Phone.-................................ Installation hone.............................••-••-- Installation will serve: Residence M--Apartment House ❑ Commercial ❑ Trailer Cou x 4 ❑ Motel ❑ Other ❑ Number of living-units -- - . Number o bedrooms _ _- Number bf baths r-. ,__ Lot size 3!-- ___l y�__-•-__-_ Wa+er Supply: Public system�Q�Communit, ystem ❑ Private ❑ Depth to�Water Ta e (Qf,� t. Character of soil to a depth of43 feet: Sand Gravel._❑ -58ndy`Lo m ❑�Clay Loam ❑ lay ❑ Adobe[} ardpan ❑ Previous Applica ion-Made: 11f yes,dote--.---.--'._ ❑ [Y- FHA/VA: Yes ❑ No Ki— l� iA� ,� I No [� New onstruction: Yes ` No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan-r cessp 1 I pirmitted if public sewer4s available ithin 200 feet.] p ` A -4 tante from f undation.. Material S til �f Not of comp artments--well-'. Srz --------------4 x e ----------Liquid depth--�I--------------- --Capacity Disposal Field: istance from neares ` well ---" ___-_Distance from foundation_-_-_.. ---� +rC P tY ........••-- le -_._.-Distance to nearest lot line.... __. umber of lines_-_..---_ ✓___ ____________`--__Lan Length of each Line Width of trench.- ---••-•-•----------- � ,�/,/ T e of filter material t •/ _ir �� . r ` ''� YA :Depfih of filter Starlet--�//X�� -------- length---• _----,..-••----••------••- \ , Seepage Pit: Distance to nearest well--- '�4--____Distance..from fndation___ .� V ___-..._-!ii)istance to nearest lot line--sr � ®� Number of pits------- Linin ;materiae -__Size: Diameter,-. - / �� , Depth- L-141 • ----------- Cesspool Distance from nearest well----------------tiDistance from founda.tio w N46ning ' ❑ ❑ -------- mate ria l-..-----_Size: Diameter----•---------------------------------Depth---------------- -------------- ---- Capacity ----------- Privy: Distance from nearest wellDu ----•----- --•----•-•--------gals. Distance to nearest lot line- -- • --- ancrom nKrest building _-------__--------------------------------- • •••........ e Remodeling and/or repairing (describe)--------------- --- ----------••-------------•-------•------------------•-------- -----•------------------------.....................•------------.----------------------------------•--•-----•-----_-.--------------------- �._ ----------------••---------------------••--------•---------•• - " - -- -------------••---- -------••--------------- 1 hereby certify that I have prepared t S76pplication and that the work will do a in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Heal t District. (Signed)------------- ---------------------- (fid/or Contractor) BY: -•------------ !'�� (Title) �,• -r�/------- -- ..................... (Plot plan, showing size of lot, location of system in anon +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- ----- DATET -' = ---------------------------- REVIEWED BY------------------------- ------------- :•.:::----_:::_-=- _ :_.:•DATE--------•-------- ....-.- ---------------•---•-•--•--- BUILDING PERMIT ISSUED-----------•---------------- - -- ------------------- DATE -- -------------- Alterations and/or recommend' tions:--------_ s-7--4- ...?"..-:_�-L`_- Lam,<� -.�- � -- ---------------------------------------------•----------------- •------------------------------------------------------------ FINAL INSPECTION BY----- ------- ------- -- --------•----- Date----- f . .-. . --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT :-, �:. �` KF. � 130 South American Street 300 West Oak Srrgt r N i 24 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California .!5co 6.59 2M 3-9-1 ATLAS