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FOR OFFICE USE: ............._.__.______.___.____________-_.__.___._. APPLICATION FOR SANITATION PERMIT Permit No. .__�1,�� -------------------------------------------------------- (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ....................... Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I"WY S'e? IV-SlO ��r✓SEM 7V4-4V JOB ADDRESS AND LOCATION T l 5'�`` Z -=7--•----•--------- --•Cis:------�� ---------------------------`---` `"` -••---- Owner's Name...._.rVief! .........��-------.- . Phone.................................... Address-__-------------------------- -: ._7!VZ____j. ......................... Contractor's Name---------- 5.----"_-C......................•...... Phone...l� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [j Number of living units- --- Number of bedrooms _�Z-- Number of baths .f5_ Lot size --------6-----.oy Water Supply: Public system ❑ Community system El 'Private Depth tc Water Tabl;iP ?"ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No e New Construction: Yes ❑ No 0` FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:, 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well_-_-_r.___-----_.Distance from foundation----------------- --Material__-_---.-___.-.--._-.-._.- _.•___.....-.._.... ❑ t`X� �N6 No. of compartments--------------------------Size------------------------ Liquid de th--_-_-----------------;Capacity Disposal_Field: Distance from nearest well....---.Q.-`...Distance from foundation....'$70........Distance to nearest lot line•..5 ....... mC X Is7/N6 Number of lines-------------- ] cr it j --------------------Length of each line of trench.-----'�-�------------------- ,IDA Type of filter material....1�E' .LC-----.--Depth of filter material-----_Zff_" _-_Total length_----_-_--iRK2-1.................. Seepage _Pit: JNGDistance to nearest well-_/0- .._-___-f Distance from founclation___,4 -_--.Distance to nearest lot line... ® ��D Number of pits------1..----------Lining material.. Q k_-:.Size:'Diameter----- �3-yV'.-..Depth--------V�, ------ P Cesspool: Distance from nearest well.-------------_Distance from foundation--------------------Lining material..................................... ❑ Size: Diameter------------ ---------------------'----Depth-----------•- _-----------_----------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well------------------`------------------------------Distance from nearest building.-......................................... ❑ Distance to nearest lot line-----------------------------------------------------------------------...-----------------•-----•----I...... ..... = Remodeling and/or repairing (describe):------• -------�-�---�----•�'�Yl�'�-"�"��'------=��.:�`��=------..--------------- i i 1 ,� ► ----------------------------------------•------•---.-..._....-------...---------------------------------------•-------------------•-------------------------------•-•--•••---..-..--------•-------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed) '��:.® /Sfj�. cs©/}-•5-----iii! ' (Ow r and/or Contractor t �� _.= 4 BY= '— r ------------- ... ----- Title 1 •-- ( )----=--- a - -{Plot pian, showing size of lot,-loco ton•of system in relation to-wells, buildings, etc., can be placed on reverse side):.—�_,;::�.,.:,. P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------- DATE..2A---,_1_- REVIEWEDBY------------------------------------------------------------------------------------------------------------------••-•------- DATF- -------------- .._..-----•----- BUILDING PERMIT ISSUED.....................................................•-----------------------•----------------------- DATE-----------------------•--•------------ ................... Alterations and/or recommendations-------------------------------------------------------------------------------------------------------......................................................... i •-----------------•-----------------•--- -.-•-• ------------------------------r-:------••---------....-..-....--------------•---......--------------------. ---. --------------------------------------------- •--•----------------------------•-------------------------•-------------..------------.-------------------•-------------------------- ------------------------------ ' ep # ._.-..------------------------------------------------------------- -----.....------- ------- ---- -------------------------- ------------------------•-------------------------------------------- .. ----...-...-•-----•......................... -------••------------------------------------------------------------------------------------------------------------------------------------------- .-. --•-•----------- FINALWSPECTION BY• . . . • ----------------------- Date--- ------------------------.----------------:----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Stockton,California lodir California Manteca,California Tracy,California ES t9 REV19E0 8.59 QM 5-61 ATLAS