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FOR OFFICE E _3:0 APPLICATION FOR SANITATION PERMIT Permit No. _..,13.5�........ -------- ---------------------------- --- --------------- (Complete in Duplicate) f, -------------------- This Permit Ex ires 1 Year From Date Issued Date Issued .____-J/116 f 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. 49. JOB ADDRESS AND OCATlQ�i�l._ ,, II-Ltrp' '1 P - •f -----------------------------------••-----•---------------------------------------- Owner's Name______,e0 •-•--••-----•---- 1 Address----...-- �f8�+ M .. Contractors Name.------- _444:2V----------- ------ Phone................................... Installation will serve: Residence EKX'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-__ Number of bedrooms 6'_- Number of baths 1____ Lot size,V �i _� ......................... Water Supply: Public system ❑ Community system ®-Private ❑ Depth to Water Table . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g"l lardpan ❑ Previous Application Made: (If yes,date--------------------I No R�1' Now Construction: Yes ®'"No ❑ FHA/VA: Yes [s}--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel --------- Distance from m foundation___r� ____-_._Mate iai____ ments No. of compart .._ ___._________Size_r:`%__ _ --Liquid depth_- --- Z-_____--._CapacitY___�pQ__.__ Disposal Field- Distance from nearest well__-"s"'""..-_Distance from foundation.... 4p--------.Distance to nearest lot line--e3'------__. s� Number of fines--------, --- ___ _ Length of each line------ es �____.__.Width of french-----�--------------------- Type of filter material.. _ ______ Depth of filter material_/e!C_-------Total length.____/>e��__ ________________ Seepage Pit: Distance to nearest well---------- ---------Distance from foundation--/a.........Dista�e to nearest lot line____��____.___.- Q ` Number of pits-------- Lining material__ .Size: Diameter-J.xx+ `--..-___Depth--,- Cesspool: Distance from nearest well-________________Distance from foundation---------------.____.Lining material___.______.______.__________._-_-- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------.-------------------gals. Privy: Distancefrom nearest well------_-------------------------------------------Distance from nearest building-----__---_____________--_-____.___._____- ❑ Distance to rearest lot line =-------------------------------•------------- - -------------• -------------------------------------------------- 4 Remodeling and/or repairing fdescribe ---------- �(jt,! _ � _- _- --------------•--------•-------------•-- - ----------------------------------------" m -----------------------------------------7------------------------------------------ -------------------------------------- -----------------------------------------------------------....----------------------------------------------- ----------------------- Lhereby certify that-I have prepared this application and-fhat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 51 ned ( g ) 4�.� ' {.Awrtedr Contractor} By: ---------------------------------=--------------- - --------------------(r+Ie} t. - ..-..---------------------- f (Plot plan, showing size of lot, location of system in r ation to wells, bui dings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED --- ------------------------------------ DATE........ - f-------- ------------- REVIEWEDBY = -•--------------------------------------------------------------- -----------------------. DATE { BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--------- -------------------------- Alterations and/or recommendations:___.-__..................___. .. f -•-------;7------ ------------' ------------------------------ ------ ` _j __ _ _'__..._.. ____ .---------- -------------- -_-__________ ._ ' = ; ---------------------------------•-• -- r 1� '� L � c.• x �'�` �/� :E •-= _:_ FINAL INSPECTION BY:.- r. 'Date---------/..................------------------------------------------------ ;. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California- Lodi,California Manteca,California Tracy,California EB-9 REV19[0 a-59 F.P.00.aM 6-60 ,