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}� FOR OFFICESE: {� !3dAPPLICATION POR SANITATION PERMITPermit No. _/ ------- --------------------------------- ------------- ------------------------------------------------ -------- (Complete in Duplicate) ___________________.______..__ This Permit Expires 1 Year From Date Issued bate Issued ....._,_____ --�-------------- - 1�3 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This pp is made in compliance with County Ordinance No. 49. '(2-6 Sc tnAD �o S7` ' 5 ' f � "�'�z" JOB ADDRESS AND LOC TION. ------------------- .. f _ � � / ' — � Owner's Name-------- �_.__ ------------- Ph one._.. ..... Address4/ - -- __-------------------------------•----------------------------- --------------------------------------- .�r Contractor's Name---- ---- ---l?_. {---- Phone 6�• Installation will serve: Residence ❑ Apartment House ❑ +Commercial Trailer C u t ❑ Motel [3 Other ❑ Number of living units: -------- Number of bedrooms __._}___ Number of bathsaz -- of size ._._ 7s__. ,/9D__________________________ Water Supply: Public system ❑ Community system ❑ Private JV Depth to Water Table,34- 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 gil-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t ,� Septic Tank: Distance from nearest well_S .________Distance from foundation___Z P______-_.Material___-iCIO _.__________ __________________________ No. of compartments______ Size__ ___ _ 6._._.___Li uid de th--------- -__ _y/ Ca acity-/*?0�.+ r X 9 p. - aZ------- p Disposal Field: Distance from nearest well._$;�}__-------Distance from foundation__..44------ to nearest lot line.__Z.-:._.. h Number of iines_________-3______ _ Length of each lineX4__ S-�aa- _.Width of trench.___ _ -___-f___________ {,) f Type of filter materiaL_S'�_CtF__4-___Depth of filter material--- length__________________ _______________ Seepage Pit: Distance to nearest well_.104-________-Distanc rom foundation___--4_.........Distance to nearest lot line------7 ___-7 ____ S ` Number of pits------ ---Lining material_ Q __.__.Size: Diameter---- _ _...__-__-Depth------ -_f________________: • Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ ` ❑ Size: Diameter--------------------------------------Depth---•----------------- -----------------------------Liquid Capacity----------------------------gal . _.____...._Distance from nearest building ________________ Privy: Distance from nearest well---�---------------------------- -- 9 ---------------•--- � ❑ Distance to nearest lot line__, ---------- ---------------------- •-------- -----------...--------------••---•-------------•-••-----------------.- w G r V Remodeling and/or repairing (descrii�e):_ �15;1—`r�-- _f' t �-= �, ••A q-------- .=y --------- ---•--•-- -------- ------ --------- � _,5 f�f._ F__' ------•-------•-----rr --------- --- -------- ------------- a ------------------------------------------------ ------- 1 •------ ------------------------------------------- --------------- r -------------------------- — j. ----------------------------------------------------------------------------------------------•---------- ----------.:...-----------------------------------------------------••---------------•--------------- I hereby certify than I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tate laws, and *s and regulations of he San Joaquin Local Health District. '--- .. _ ------ ------ --- ------------ ------------------------------ --••---g-VOwner and/or Contractor) [Signed)--- --- -------- --------- ---- - l�-----= -- y By--------------------•- p�-' (Title) ------ (Plot plan, showing size of lot, location of system in re ion to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ _'"ZEP --------------------------------- DATE f' r C� ------------------- REVIEWEDBY =-r--------------------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED---------- ----- -------------------- DATE--------------------------------- Alterationsand/or recommendations:----------------------------------------------I---------•--------------•- --------------------------•--•----------------•------------------------•---------•---- -------•----------------------------------------------••-- ---•-------•------------------------------------------------------•------------------------•--•-----•--------- -------------•---------------------•----------•----• -------------- ---•------------- -•-------------------------------------------- -------------•---------------- ----------•--------------------- -----•------------ ----------•-------------------------------------- ----- ----- -• ----- .......... .------------------------------•----------------------••---•----------•-----•--------------------------------------------------------- FINAL INSPECTION BY:.------- Date ----- `------- `5 r ------------------------------ 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 TraWr California EB•9 REVISED 9.99 F,P.CD.SM 6.60