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FOR OF F I C EQ6 E: a , �z---- ---- ---- --------------------tl---------------------------- s. . APPLICATION FOR SANITATION PERMIT Permit No. _/I -------------------_--- --------------------------------- (Complete in Duplicate) Date Issued ........................................ This Permit Exeires I 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 *n compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION.____._. ------------A�/' ......... ..------------------I------------------------------------1-------------------------------------- Owner,S.Name....40'WK0J*.t-------PAe1e%r.;?_ S ------------------------------------------------ -------------------------------------------- Address----------------- ------------------------------------------------------------------------------------------------------------------------------............................. Contractor's Name----- ejo ------d_g!�Craw ...... . ------- -------- ----------- Ph o n Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel [] Other 0 Number of living units: Number of bedrooms ./... Number of baths _/.. Lot size.----Ono--- -.-.!r..!e!:0.,x2....................... Water Supply:. Public system pCommunity system 0 Private f❑ Depth6 fo Water Table ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam 0 Clay Loam [3 ILClay 0 Adobe, Hardp' a--n 0 Previous-Application Made: (if yes,date____________________) No NJ New Consfrtiction. Yes E] No R] FHA/VA.. Yes E] No El TYPE OF INSTALLATION AND SPECIFICATIONS: IV (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septic Tank: Distance from nearest well.................Distance from foundation--------------_----Material................................................. El F>tSrl*6 No. of compartments---------------------------Size-------------------------------Liquid cleph--------------------------Capacity....................... 77. " 'I I- L, Disposal Field: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line....___..__...... ❑ EpS;-1*6 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- 90 MAU-: Type of filter material-------------------------Depth of filter material---------_------------Total length.........._._......__...____.____.......__ Seepage Pit: Distance to nearest wel I__NOWC---.-Distance from foundation...AP.4---------Distance to nearest lot line____ ---------- Number of pits-------/.._.....-__Lining nraferial-INja <-----Size: Diameter.- .Depth__..._._, ---------- Cesspool: 'Distance from nearest well-----------------Distance from foundation--------------------Lining material___-____-_--___________________---_-- Size: Diameter--------------------------------------Depth.................... ---------------_------------Liquid Capaci 13 ty............................gals. Privy: Distance from nearest-well------------------------------------!___._._______Distance from nearest building-._..._......__............_.___..__...... Distance to nearest dot line---__--------------- ----------------------------------------------------I----------------------------- Remodeling,and/or repairing (describe):--------of.,DP-------:27?kee�>------ --- - - ------ °--•-------------------•---•------------_---•------ -----------------------------; - I I I --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ......................... ---------------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 regulations of the San Joaquin Local Health District. ei t is --------------------------------------------------(Owner and/or Contractor) BY:... --- ---11--(Title)-------2TZ- �74--------------------- ------------------ ----------------------------------------------------------- (Plot plan, showing.size of lot, location o �.isysfem in relation to wells, buildings, etc., can be placed on reverse side). lk DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---------------------------------------------- DATE----------- - -- ---- REVIEWED BY.............. - ------------------------------ --------------------------I-------------I....................... DATE--------_-_------------- ...............--------------- .................. BUILDING PERMIT ISSUED---- ----------------- ------------------------------------------------------------------------ DATE--------------------------------------------------------- Alterations an4kor recommen4,a�ons:,- -------------- ---------------IL --_------------------i------------------------I......... - -- - ------------------ --------------------------- --------------------11............. -------------- -- -------------- 9--------------------------------- ---------- .......... A& / ------- -- ------------=---------------------=----------------------- ------ - ----------------------------- ...........;................ ....... ------------------------ ---------- .... .......................................................-...-.....-........... ................. _ . -A-- --------------- FINAL7INSPECTION'6Y:----------- - ---------- --- -- - ---- Bate----- -- ---- -- - ------------------------ 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 ES 9 REVISED B-59 RIA 5.61 ATLAS