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FOR OFFICE USE: --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...1.., __/.�'.�` ---------------- --------------- ------------- (Complete in Duplicate) Date issued -------l.��-_-- --_..._______________-_------.--.--.-----.- ___.__. This Permit Expires 1 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 with County Ordinance No. S49. - o # `---- f�ar<r �.✓_. ,--:: 4�✓dr----"--- c'•' ac- _�� Dr------------_---- Owner's ADDRESS AND-LOCATION------ -----------------. �_ 1?, Owner-s Name--------� �eY} 1�-�`` � ~ ---•----------------------------- -----------------------------------------------------•- ------------------ •------------------- Phone.._-..__.-----------------------.... I �- 6 .. Address----------------- = 3 S° 't° ---------- - --r--------------------------------------------------------------------------- -- ------------ Phone....jv_! a 6�� Contractors Name--•- .----••-•- °a - •---9--------- --------�-C'-�-•----•---•---•`---•_-----------------------------•---•--•-------•- - ---._. ..------- ' Installation will serve: Residence [pApartment House ❑ Commercial E] Trailer Court L] Motel El Other [3ti Number of living units: -_/•--. Number of bedrooms Y___ Number of baths Lot size ___________________ Water Supply: Public system ElCommunity system Private E] Depth to Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No-Zj-- New Construction: Yes EY-T�o ❑ FHA/VA: Yeses—No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sevrerjs available within.2Q0,feet.) Septic Tank: Distance from nearest well------—------Distance rom foundation-_._1,07_-----.Mate ial _r.31_� ...--_---- ._---- � No. of compartments_______ -------.._._Size _. ��-:_--Liquid depth_.__" ,'.- Capacity__ ------- Disposal Field: bis#ance from neares well...."`-.._.Distance from foundation--- ___ __ I�_�..__.Distance to 'nearest lot�ine____-�__��___. Number of lines_._._-/— . . Length of each line----'_29_`%__-�f---_.Width of french_-_._��-____f____. ---------- Type of filter material .�y L��-Depth of filter material__-_/e--______.Total length_-_-_._•`�� ----------------------- Seepage __________________ Seepage Pit: Distance to nearest well-- ----'------ Distance fr m fo ndation------------------- Distance to nearest lot line-- .--'----- I Number of pits------ Lining ma#erial___ ✓�-- ----_---Size: D'sameter__s.7 !!�f p ,. Cesspool: Distance from nearest well-----------------Distance from foundation.-.._ _--_---.Lining material-______--_-_-______-----_--_----_--_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------..gals. Privy: Distance froim nearest well----------------------- ---- __----.-__Distance from,nearest building-------------------------------------__._. ❑ _ _- - ..t.-..�_ Distance fo nearest-lot line"-�----�---�-+------------------------------ •• --•-------------------"-- ---------------------------------------------------------------- Remodeling and/or repairing (describe):------------------- �`"' = � -----------------------------------•--•----•---------- --••-- -------------------------------------------------------------------------------=---•--- ------------ �------------------------------ ----------------•----------------------------------------------------------`---------- f ' { I ------------------------------------------------------------------------------•--_--------_____•___--_-_-__-_-_--___-_---___-___-____-_---._........._......_...._.-..-_--.-_.-----_.-______-------_-----_----.__-__--.__----- ------------------------------------------------------------------------------------------------«...__.--_--•_•-».-•.---_---.----__-__-__------.-___--_--_-------•_._----___--____----_-----___--.-----------.-_--_._--.----- � I hereby certify that I have prepared-this application and that the-work will-be-done-in accordance with San Joaquin County ordinances, State laws, and rules and regui tions of the San Joaquin Local Health District. 3 ,i .r . [Signed}---------------------------------------- --- --. - -------------•-------- [�r Contractor) By:------------------------------------------------- �'---- -----[Title}_ fr'�/� ---------- - - - ------------ - � (Piot plan, showing size of lot, location if system in rely to wel s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- -•-- - -----_. DATE_____> _-- REVIEWEDBY--------------------------------------------- ------------------------------------------------------=------------------------- DATE---- -----•--.. ` BUILDING PERMIT ISSUED---------------------=---------------------------------------- -...................................t__ DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------- -------------------=-----•-••--------------=--------------------------------------------------------------------- ------------------------------------------------------------------- ----------------------•----------------------------------------------- -------------------------- - ----- -------------------------------- --------------------------------------------- - -----------------•---•--•--•--------------------•-•---- •-------•---------------------------------• ----•--•-- ..................... 1 FINAL INSPECTION BY:. 1 ................................ Date----- -------------- ----------------- ------•---- 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 E9-9 REVISED 8.99 r.P.r C.2M 6.60