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F R OFFICE Uf E: ' -------------- -_------- APPLICATION FOR SANITATION PERMIT Permit No. ._ ......7.�.:.. ----------------------------- ----------------- (Complete in Duplicate) _ t . t._ v - �- Date Issued / -----__-____--__ This Permit Expires I Year From 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�th County OrdrZ/-luo . S49JOB ADDRESS AND ATION_ ��-__ -_ - _ —d- ---------------------- ---- ---------------------- Owner's Name f -•--------------------------------------------------------------------- Phone - �2 Address i `M•-�------- ---------- -- Contractor's Name---- ---- .------•----•---------------•-------••----- --------- I ` ..' -- Phon t�O L'I ---- t Installation will serve: iResider cex . Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units _I Number',of bedrooms _ _ Number of baths J---- Lot size __ _C _ ___ _�� __ _________________ i :a _ ...� Water Supply: Public system ' Commun:ity system 0 Private ❑ Depth to Water Tablez_ft. Character of soil to a depth of 3 feet:.1 Sand'❑ Gravel ❑ Sndy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan C]Previous Application;Made: {If yes;date"________________-1 No New Construction: Yes ❑ No FHA/VA: Yes ❑ No V Ir TYPE OF INSTALLATION AND SPECIFICATIONS: i (No,septic tank or cesspool-permif!'ed if public sewer-is_available-within 200 feet.) ! ❑�Cl� Septic Tank:: Distance from neave t well e,ll___-1________---_Distance from foundation.......-------------Material______________________________________________-Sco Vt F - -------------Size------------------------------------------------------.-Liquid depth----------.---------------Capacity----------------------- Disposal Field: ; Distance from nearest well-k-0- -.Distance from foundatio ___w ---- to nearest lot line_ �....... r Number of lines---(��-------------------Length of each line__ __�______ r: Width of french_"-4__t ( YP_ � 1psf " Total length-.------ ength T e of filter material-_-Q_�(. ---------De th of filter material_____ . __ ____ Pit Numaber of nearest well_�CUQ1U pistaac e,from :nDiameter .'Distance to-nearest lot line__-�.. C Seepage � � _ tr � - R p r 9 __ Depth__ S _. Cesspool: i Distance from nearest well________________Distance from"foundation---._-____--__.___.Lining material____-________-_____________-,__-____ •_ ----------------------------- ------ - --_--._Liquid Capacity �,- � ❑. � . . S¢e:"Diameter---------- � Depth----------------------F------------ - 9 -----------._...------------gals. Privy: a Distance from nearest well ----___--______ ___----------------------------Distance from nearest building------------------------------------------ El k Distance to nearest got line` 17--- --------------------------------------------•---------------- -- .e f Remodeling and/or repairing (describe: - -_ --- -- --- - -•-- -----------------------------------------------•- -------------- -----------------------------------------•-----•----------------------------••------------- --------------- ----------•----------- -----------------------------------------•---------------------- ----------------------------- ------------------------------- --•--------••_--_••---.-------••----•------------------------ ---- I hereby certify-that'I have prepared'this Rlicati n and that.the work will be done in accordance with San Joaquin County ordinances, State 71aws, and ules and regula ' ns f theS n Joa uin Local Health District. (Signed) - f ----- ----------- (Ownar and/or Contractor) B4�------- cC --- -- --------- ------�, - _(Titlel -- - Y = f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pl d on reverse side). FOR DEPARTMENT USE ONLY t I APPLICATION ACCEPTED BY `J DATE ' --�^ REVIEWEDBY ,,L--------- `_ - — - -------------------------------------------------------.. DATE------------------------------------------ BUILDING PERMIT ISSUED---------------------------- 1-------------------- DA•TE_--------------- Alterations and/or recommendations: -- =""'`.- - �= '----------------------------------- - "= ... '� � = � ------------- ---------------_--•-------•- ----------------- -; . ---------------_.--------_----------------------------------------------------------------------------__-____->------------------------------------------------------------------------------ -------------------------- ___________________________------ -- _.-----------------------------------------------------------------------,____,-----------------------.__-_-__-_ ____________-.____-______.- rrr - FINAL INSPECTION BY------------- - - - - l- zr------------- Date------------- / -7 SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 124 Sycamore Street Y 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E13-9 PrVI9E0 9.59 F,P.CC.2M 6.60