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Permit No. APPLICATION FOR�`SANITATION PERMIT14, o r� - _ p (Cornp!-et'0 Duplicate} • ,,lT ' 1 Date Issued -'----•--------------- Application is hereby made to the San Joaquin Local hHealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. `-JOB ADDRESS AND L ATION -- --- f --- y f Owner's Name------:---. •- L- U/ /----------- } ��-� F Phone Address--------- Contractors ame --------- -------------------------------------------------------------------------------. Phone----------------------------------- Contractor's ---- Installation will serve: Resi encu Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 7- Number of baths ._�`_�Lot size __.-j.-.._.- - --------------- Water Supply: Public system ❑ Community system(❑ Private Depth to Water Table ft. r Character of soil to a depth of 3 feet! Sand ❑ Gratel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous.Application Made: Yes ❑ Nok New Construction: Yes, No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted,if public-_sewer,is,available within.200_feet.) - ptic nk: Distance from nearest well-_-----_--------Distance from foundation__________________.Material------- -.--.-....---------_.-.-----------...._. No. of compartments------------- ------------Size--------------- ------------Liquid depth--- ------------------ Capacity----------------------- isposa eid: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line--------.---_--_. ` Number of lines---- -------_---------------------Length of each line------------------------------Width of trench----.--------------------.___------ Type of filter material-------------------------Depth of filter material------------ .---Total length-!--------------------------------- ------ r Seepage Pit: Distance to nearest weIV"----.-------Distance from fo datio ------- ___ __-.Distance to nearest lot line-._,�5------ Number of pits__ �1 ------------Lining material_ _. ...-._- Size: Di meter-__- ------------ Cesspool: Distance from nebest well.................Distance from foundation___-=.-.--.Lining material----_---.----.--------...__.._---_-. ❑ Size: Diameter----- - Depth--------------------------------- -----------I------Liquid Capa ity----------------------------go[$, G,,,.,Jrivy: Distance from neatest well_ ......_-..---.---------------Distance from nearest bur{ding_---__.-_.----------------------------- Distance ..__.._..___._--_--- .----- Distanceto nearest lot line---- ---- ------------------------- ------- -------------------------------------------- - ---------- ----------------- ---- Remodeling /�� and or re airin Lri :_=: ------------- p - e ' - ---- ------------ ----------------------- ------------------ ---- --------- I --- �__-�= -:---------------------------::::--=_=:_:------:------------------------------- -------------------- y -i F `IY .................................... _ ____. _---_-___--_-_.--_._....---._____...._.____-......-____-.-.._____ ....__..____...._.__.__..-___-.---_--.-......_.-...____._____-._.._-.-__.-_------.-.-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to b)v law , rules and regulations of the San Joaquin Local Health District. (Signed} l - Owner an ontractor} --j�------------=----------------------------------------- ------- ------------- Titl (Plot plan, showing size o lot, location of system in relation to wells, buildings,'etc., can be paced on reverse side) r FOR. EP,A 'yMEr USE ®,NLY4 APPLICATION ACCEPTED BY-------- - - F = ; DATE:-� -- -------------- REVIEWED BY------------------- ----------------- -I------ ---- ---------------- ------------------ ---- ------ DATE--7___ '------------•----------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------ } - -------------- DATE----------------____77" -•----------------------------- Alterations and/or recommendations:_.------- __.-.----__ t `` a _ ---------- --------------------------------------------- ) _ --------------------- ��% r � --- -- - ------------------ -- --------------------------- ---- -------- --- --- ------------------ ------ --- ------- ------------------------ -- ---------------- fi ---------- ------------ --- - ------------------ ------ -- ------ -- -------:----.'C --- De ` V 41 FINAL INSPECT _ - ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT !S 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California l z E$-9-2M , Revisea 1.57 F.P,CO.