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/ FOR OFFICE USE:--------------------------- ------------------------•----_ __--..-..__.--- __i-___ APPLICATION FOR SANITATION PERMIT Permit No. .��.��C�-_� (Complete in Duplicate), --------- ----•-------------------------------------- ,. ------= .. . a_. ..Da+e.Issued ;� --- _ "`-This 1Pelimit Expires 1 Year From Date Issued Application is hereby made:fo the San Joaquin Local Health°District for a permit to construct and install the work herein described, This Ica Ion Is cbmpliance with County Ordinance No. 549. l ��' 6 rt �� i` . t JO CATION a. r ------ --- ------ -- --- - --- t« --------------- Owner's Name f`^` .._. -- - ---------- Phone.;/ Address----------- 1.3 - I .7,LtL -= r ---------• ----•- Contractor'sName------ �(t �.... , lnstalla+ian will serve• Residence flpartment House -------------------- ----- -•---- :- - Phone,_-.--------___--_--_---_--___------ i • ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other 0. C �. : 0 Number ofi living units: Number of bedrooms -- _ Number of baths -- Lot size ---'�_ ',t J14/a�_•____________________ Water Supply: Public system Community system ❑ Private ❑-• Depth to Water Table 4:98r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Lo' andy-L'`o ❑ Clay Loam ❑ Clay ❑ Adobe ja Hardpan ❑ Previous Applica+ion Made: If yes,date------.-----.- ----- No New Construction: Yes No ❑ FHA/VA.. Yes ❑.-. No,QJ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellDistapce from foundation_/10-/10 --------.Material __,__ - Disposal Field: �Disfance:,lmpartmerts.._- -. ---- -----Size,' __ --,.$'_....Liquid depth--------�--------------Capacity__. '?rL No, of co p ,} from nearest well._;.- — _,Disfance from foundation__J[c�!_-_---_.Distance to nearest"lot line..... '--- Number of lines---f 1 ------------- �__--- Length of eacli.line-..._-��-__--- Width of trench------ -,Type jf -,Type of filter materia��,p "' De th=:of filfer'material-_-_._f+�_�___-Total length____ ____________________ Seepage Pit: Distance to nearest well _ _ _Distant from,foundation__�0�._--_-_.Distance to nearest lot line;,--- ` {' AAJ .Aumber of its---�' ------------Lining materi _�jSize: Diameter-33 f-_-------_Depth_.a2.'�---------------- Cesspool: ----•----- ----Cesspool: Distance,,from nearest well------------------ Q `l` i Distance from.foundation--- -------------.Lining material.,..----"-.---------.._.----.._-- k , Size: Diameter. Depth=: -------------------------------Liquid Capacity-----------•------- -gals. Privy: Distance from nearest well----- ---------'_ _ _ Distance from nearest building-------- ------ •------------------- ------ ---- \ ❑ Distance`to nearast,'lot line". -----_. __ --------------------------------------------------- Remodeiing and/or repairing(describe):------ --------------------------------- =f' ----------------------- ---------- ------'--------------- ----- - . - - -------- ----------------- 1. i----------•-- ---- ! hereby certify that I have prepared this a'pplica+ion and thai.the work will be done in accordance with San Joaquin County ordinances, State laws, and es;and regulations of the San Joaquin Local Health District. (Signed)------ _ -= ' :.. - ------ ---------------------------------------------------(Owner a r�_d -- " _ _==By:-=---------- ------ ------------(Title)------------ (Plot plan, showing sire.of lot, location of sy m in relation to wells,'buildings, etc., can be placed on reverse side-- ' r T FOR'DEPARTMENT-USE ONLY t41 APPLICATION ACCEPTED . DATES-" (O ----------- REVIEWED BY_----------=F' = z BUILDING PERMIT ISSUED--1l-----%rv- _ DATE -'-`----------------------- DATE.---------# = Alterations and/or recommendations:.-- --'-.._____--- .. - V _ ---------" -------------------------- •-------•---•-•-----,...----.----....------------ ------------ ----- ` - ------------------------------- ----------------=----------- -•----------------- .------------------- ----- ` --------------- •E - ---- --------• FINAL INSPECTION .�.: - v - } - - - Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 124 Sycamore Street 205 West 9th Sirest Stockton,California I Lodi,California Manteca,California Tracy,California ES-9 REVIEEP 9.59 r:P.CC.2M 6.69 I�