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FOR OFFICE USE: ✓ A r< 1 D- 3 aAPPLICATION FOR SANITATION PERMIT Permit No. ....t _ . -------------------- -------------------------------- (Complete in Duplicate) Date Issued __��/6 f This Permit Expires 1 Year From Date Issued. / �3—£&C, -S7D 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. X14-E �i1e01f� 7Lfo 4-00 JOB ADDRESS A° LOCATIO -_ 7/1. 1C'�" --- 615 ._1 � � ,�" � �� _4�� Owner's Name----- .{1 1 �LA------------ -------------------- .--------------------------------f-------- Phone. Q�s� a�j9 Address------------ -------- 'TT+-'-...1 , ..=------ 1' ------------------------------ Contractor's Name r• - '.e 41.7- - --q3? -1! _,o-A&A: rt/.C-----------------------•-- Phon ..._._. - .. Installation will serve: Residence Apartment House F1 Commercial [3 Trailer Court [j Motel ❑ Other [INumber of living units: __ Number of bedrooms Number of baths _ ___ Lot size .l--Q- --`- -_til.- ••-------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 2, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No.$j( FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.-J--____Distance from foun lion.-I-_Q__.or___-_.Mater alb___ ------- No. CNo. of compartments---2-----------------Size___ Liquidy-.- 41, � 4 . /O..' .-Distance Field: Distance from nearest well,-.5D...._,Distance rom foundation_________ _____ __Distance to nearest lot line___ Number of lines________ Length of each line__!...........Width of french. �______________ Type of filter material___.__ _s ____ __ Depth of filter materia-__-J_�_ ^ Total length---------�.,�__L___C.`.9____ _______________ Seepage Pit: Distance to nearest well-_--_60----_Distance from foundation-__ dr ...___.Dista` ----- lot Depth-------. ------------•-----•-•• Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material------..----------------------------- ❑ Size: Diameter--------------------------- ----------Depth--------------------------------------------------•-Liquid Capacity--------------------- 9a13" i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------.--.----------- d F1 Distance Distance to nearest lot line-------------------------- ----------------------------------------- ---------------------------------------------------- ------------------ Remodeling and/or repairing (describe):---- -- ----------- -- ------ --------- -------• .. -------------------------------- - •--- - ------------------------------------------------------------------------ --------- ---------------- ------------•------------------------------ --------- -----•------------------------ --------------------------------------- -------------------------------------------------------------------------------- --- ------------------------------------•-•---------------------- ----------------------------------------------------- I hereby cerlt*LTfX that I have prepared this application and that the work will be done in accordance with San Joaquin County., ordinan s, d rule and regulations the Joa uin Local aI District. w (Signed) -- --- ---- -- ---- ----------- ---- ------------------------------- ontractorl I By----------------------------- - --- --------------------------------------- -----------------(Title)---------------------------- - --------- - - ----------------- 5 (Plot plan, showing size of lot, location of system in relati o wells, build* s, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ----------------------------------------------- DATE----- -------------------- REVIEWEDBY---------------------------------------------- -------- ------------------------- ----------------------------------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------- _. DATE..- Alterations and/or rec mendations:-.--1- /O___-_l_ _______� _ - - .....I-------- --------- - �n-f1 � rs --- -- ------------------•----- ----•--•------•-•-••-•----- FINAL INSPECTION BY:....V---�----- - =� �------------ Date. �. `-�.l).~ i" ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California EG-9 FEVISKO 8.59 P.P.00.2M 6.60