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t-UK VI-M-1: USE: --------------------------------------------------------- `` -_-________________________ ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __��!_Q---7_?, (Complete in Duplicate) Date Issued _ �Cy �- ------------=----------------------------------------.--- rThis,-Permit Expires 1-Year From Date Issued y`. -- — cj Application is hereby made to.the San Joaqu01-7 Zip—f Joaquin Local Health District for a p mit to const ucctt aanclin fl the w A herein described{ This application is made in compliance with County Ordinance No. 549- 6D two lez; JOB ADDRESS AND LOCATI ,9Ui!..� �(�'3 �a �"` � `-'-- Owner's I Name_____ 4-1 _ --------- ------ Cont __/ ---------------•----- Installation will server Residence Apar tmentyHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ofher ❑ � I Number of living units. : �`_TNumber of bedrooms ._ Number baths ---l-_ Lot size ------------------ C -----_---,-- Water Supply: Publics stem pp y: system ❑� Community system ❑ I}rivate depth o Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application-Made: llf,yes,-date-__.'.__ '._�.)�LNo ❑ 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.) i Septic Tank: Distance from nearest well------------------Distance from foundation------_-------------Material _______________ , t ❑ No. of compartmenfs "=--==----------------Size_-------------------------------Li Liquid de th----------------- --- --_Capacity�.,-� q P p Y , Dispos field: stance from nearest well----- Distance from foundation___._ �_f__-Distance to nearest lot li�__.�-- 7 Number of lines---------- ------ - 67 ----- it _ Width of trench...... i-•--------- ------ I' Length of each line_______ -_ Type of filter materiaL_ epfh of filter material__-____f -_Total length___-----6--6._-_- 1 ------• ---------- Seepage Pit: Distance to nearest well___ ------------ -----Distance from foundation__________________.Distance to nearest lot line------------- ❑ Number of pits----------------------Lining material-----------------___Size: Diameter.-----------------------Depfn-------------------------_---�-. Cesspool: Distance from nearest well-------:----------Distance from foundation---.--------------- Lining material_________________ - _ ❑ Size: Diameter---- ---- --------------- ---- -�Depfh--- ---------I------------------------ -------=-----Liquid Capacity----- --------------------gals. Privy:! Distance from,near`est well_____________ --------------------------------Distance from nearesf building ❑ Distance to nearest lot line -------------------------- -- Remodeling and/or repairing (describe):-- ----- '' - ---- ., t --------------------------------------------------------------------•------------------- �r -------- ---- _.------.. .». - -- -----'•------------c------------'-----'-----•-----------------------------------_-- -------•------------------------------------- I hereby certify that I have prepared this application and.that the work will be done-in accordance with San Joaquin County ordinances, State , and rules and reg ations of the'San Joaquin Local Health - District-. (Signed -:----- --- � wrier or Con 1t r) - - ' - --------------------- rac By--- ------------ ------ - ---------------(Title)-----------------------•--------------- I --- ------- - -------- (Plot plan, showing size of lot, location of system.in relation to s, buildings, etc., can be placed on reverse side).- FOR ide).FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---, � ==-----------------............................_.-.DATE--_J' -_-_---_- .._ - - -------------------------- REVIEWED-6Y=TT "=-_.—_ =" .,•. . ---." ----------------------------------------------------------.,-- DATE j BUILDING PERMIT ISSUED '------------------------------------------------------- DATE---------------------------- -------------------------------- Alteritions and/or recommendations.--------------- --------=-------= - ------------------------- ------- ---------------------------------------y�.e--------- _ ----------___._.---�---,-1-'------ "'----------____E.._•_e_---j----•---.-4-----r------- -----------------------__--------------- ---------------- ---------------------------------------------------- ! • -- -v ---------------------------------r -------------- ------------------- ------------------- -- ----------- ------------- _ a *+ - — - ----------------- FfNAL INSPECTION BY: Date_. _ i---_�j SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P,CD.