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FOR OFFI E U E: '' ----------- / lD --------------------------- /G_ ---------_--- APPLICATION FOR SANITATION PERMIT �` 9 Permit No. _._................... ----------- -•------------•-----•---------------- (Complete in Duplicate) Date IU.yed ------------------------------------------- This Permit Expires 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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION !� �5 ------r -� ------ 51�-----•-•-------------------- --------- Owner's Name--••--------- ------j�`4-----------C.4-A.-N- -- `� CC. °N#------------------------------------------------- Phone--- ---- '9 S Address............................. Contractor's Name------------5_,VM C------------- -------------- .......... Phone.----............................. 1 Installation will serve: 'Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other-[] Number of living units: ---_ Number of bedrooms,'_-_ Number of baths __Z. . _ Lot size __-_'YY___i-C __!-57_��------------------------ I Water Supply- Public system ❑ Community system ❑ Private [K Depth to Water Table -f-O ft. Character of soil to,a depth of 3 feet: Sand ❑ Gra vel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe fg Hardpan ❑ -,Previous Application Made: (if yes,da4__ .15 .Z-) Nom ` New Construction: Yes ❑ No'�f FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: -. ( o septic ten or cesspool Permined' ifPubiic-s-ewer is available within 2DD feet.) Septic Tank: Distance from nearest well---O�Q_ - Distance from,foundation--------1 A-`----Materi ------(7•---`-'-'-'-.--�•--..-- ..................................... No. of compartments..-_-,--•-.i;�m---------Size----9_-X---3--'i''`_--�.---Liquid depth----------1•�__..-.------capacity-----5-0- ....... Disposal Field: Distance from nearest well----,JQ-----Distance from foundation-------10--f-.Distance to nearest lot line kg Number of lines--------------/-------------------Length of each line----------- Width of trench---------;?O_ f �" Type of filter maferial.. AS5;�,C�Depth of filter material__..--_..f--_---_--Total length------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----- �' ❑ Number of pits----------------------Lining material-------------------'----Size: Diameter----------_----------Depth-------------------•------------- 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----------------------------------------------------------- 1 Remodeling and/or repairing (describe)--------------------------------------- •---•---------------•-•-•-----------------•---------------------------------------------------------- --------------------------------------__---------------- --•------- - 2 4_0 --------------------------------------------- --------_---•••----------------------------------------------•-•------.-__--------------------_-_--------.__------•---------------------------•••--------------=y----••••---•----------......__----..._...-.-----`--------_-- ------••••-------•-----•---•-•-•••----------•---------------•------------------------------------••------••------------------------------------------ t 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 an ''regulations of the San Joe in Local Health District. �Si ned 9 )----�•-�-=-••- --------------- ------ --- --�'-----------------------------------��it''�--------------------------------.-•------- .-.-..(Owner and/or Contractor) By:...........---•------•------••--� -------------------------------------------------•-•-•-•-•-•--------- ---------•-----------(rtle)---------------------------------------- --- - ---.-•--•--•---- .(Plo} plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - --- -----.---..-______-----_--___------ DATE_..__---_--____2_ -- �•�_- ----------------- REVIEWEDBY------------- - ------------_--------------- ------------------------------------------------------------------------- DATE-------•------••-------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------• DATE--------•-------------------------------------------•------- Alterations and/or recommendations:--------------- ------------------------------ ------------------------------------------------------------------------------------_-- ------------------------ = ----- -------------- - �r --- ------------- -- a- 4 •� ,• `` --------------------------r .- = ----------------- i- a_- , �- • -----' ' ¢ �'+� � ------------------------------------ .-............- c ------------------- - FINAL INSPECTION 'B� -- • •-- ------- -- -- --------- --- Date--------- .G-. -..-�a 2 -----•------_-------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1 l Stockton,Californt. Lodl,California Manteca,California Tracy,California ES 9 REVISED 6.59'204 5-61 AMA9