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FOR OFFICE USE: a . _ 1s � APPLICATION FOR SANITATION PERMIT Permit No. ._ .. -----_ ----------- -- (Complete in Duplicate) Date Issued - ---------------- ------_._.-._-- This Permit Expires 1 Year From Date�lssued . DI?_ l t3 A lications hereby made to the San Joaquin Local Health District for a permi to constr ct a d install the r stein descry T Psapplica ion is made in compliance with County Ordinance No. 549 ` u: ,} OB ADDRESS AND-LO ON r --------------------------------------- Phone------------------------------------ Owner's Name = • f -- -••-------• -- •-+----- r4 --------•-------------------------------------..................................... Address---------------.. - -----•----------- Phone. Contractor's Name_ Installation will serve: Residence M Apartment.House ❑ Commercial ❑ Trailer Court E) Motel [3 Other ❑ Number of living units: _ ___.. Number of bedrooms -------- Number of baths -------- Lot size ...................... Wafer Supply: Public system ElCommunity system ❑ Private 90 Depth TO Water Table _` 9- ft. pan 0 Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam Clay Loam [IClay ❑ Adobe❑ Hard No ElPrevious Application Made: (if yes,date--------------------) No N New Construction. Yes.$J No ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: •_. -- {No septic:+ank.or cesspool permitted 1f-public sewer.is-availa6le:within.200 feet. ��t well t ation__�d_- ------.Material----C�� .. _ ----------Capacity 07R...... Septic Tank: No.aof tom artme tnce from ss .__.---•"SZeence frown Liquid depth_____�I---- p � ___..Dis#ante to nearest lot line-4.'-.. ......... V a Disposal Field: Distance from nearest well_o o--------Distance from foundation_-L ...___.._ - {yI Number of lines-----1 --- --- ------AW-Depth of each Ione____,f_0-------------------------.Width of trench-----��---.•----------------- " j� De th of filter material-------1�...-..---Total length__. ��.-----------• Type of filter materia _ ___ . _ p Seepage Pit: Distance to nearest well_--------------------Distance from foundation....................Distance to nearest lot line-_.----"--_.._.-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------------- - Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.-.____._-----.----.-----•---------- --_ --__.-Li Liquid Capacity 9 ❑ Size: Diameter------------------ ------- Depth_.--•----------:----- ---- q P tY Privy: Distance from nearest well------."--------- ------------•--- - . building. ----------------- Remodeling to nearest lot line-------------------------=----------------------------------•-----•----I------•------•-- and/or repairing describe ------- •-------- --------------------------•---•- -------• ------------•---------- -----------------------------------------------------------------•--------------------------•------------------------•---------•--------.-----••----••---- ------------- ------------------•------ ------•-----•---------•-----•-------------•----•----•••-•--...--------------------------------------------------••----------•---------------•---------•----•------------------------•-----------•---------------- I hereby certify I have prepared this application and that the work. will be done in accordance with San Joaquin County ordinances, State s, d rules and regu ions of the San Joaquin Local Health District. (Signed} --- -- ------------------------------- ----------- ---•--------.---(Owner and/or Contractor) ------------ �Y� - -----.M _::��:�----- _ v--------------- __ :.:.; (rtle}ti. _ (Plot plan, showing size of lot, location of system in relation to walls, buildings, etc., can be placed an reverse side}. ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPT Y ---------------------- • ------------------- ----------------------------------- - DATE. +'Z RATE__7",x:3_„A-:4-7--•---------------------------- REVIEWED BY---------- W ----- ------- BUILDING PERMIT ISSUED----------------------------•----- DATE Alterations and/or recommendations:-----------------------------.-_--.-_-._ ---- ----- ------------------• " 3; ---"___________________________ ...........---------------------------- ------------------ __ Lyz-_--6._ - ----------- ----------- ------ FINAL INSPECTION BY:. �-- --- ------ Date - ;Jr.. ;SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 W+croak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lod],California Manteca,California Tracy,California _ ,