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--------------------------------------------------------- k j1�3� --- -- ------1-1-------i__1_Q`�D. KI1 APPLICATION FOR SANITATION PERMIT , Permit No. .., .. .��..7- ------- ----------------------------- ------------------ (Complete in Duplicate) // --------------------------- ------------------- This Permit Expires 'I Year From Date Issued Date Issued _-.--__--___�A/ Application is hereby made to the San-Joaquin Local Health District for a permit to constr-ct) n d i 1 he herein des bed. This application is made in compliance with County Ordinance No. 549. �� , JOB ADDRESS AND SOC TION Owner's Name------------- -� ';`: = -_• --- = -- _ c=. �_-`-------- Phone.---•------------------------------- -------------- Address ---------------- -- -------- �c Address------_-- ------------ Contractor's Name c`�'1• ...__ �� ------------------------- -------------•-----••-------------------- --------------- Phone................................... Installation will serve: Residency®, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/_ Number of bedrooms _'.�___ Number of baths ._'lLot size ------- '_...Z-__-r'Y............... Water Supply: Public system [] Community system ❑ Private a Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote------- -----------) No �K New Construction: Yes �Z Nom- FHA/VA: Yes ❑ No [R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ �G__Distance from foundation--------/."_0..Material_-___ - ------ P '„r•, L�. No. of compartments--------• -:--___- _Liquid depth----------- ----------Capacity-------15�F_`--s- Disposal Field: Distance from nearest well...__.t"zJ._.Distance from fcundation..___`?__,*�1...-Distance to nearest lot line_____ [ Number of lines-------------- ----------- of each line_________ _f-------Width of trench___._-____2�---+_--_______-__ Type of filter material___ 'Y� Depth of filter material---- --/-'-.Total length........... .u____'___---__ Seepage Pit: Distance to nearest well---------------------- 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-------------------------------------- 0 Size: Diameter------------ -------------------------Depth-----------------------•----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------_-------------___--------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line Remo :ling and/or repairing describe) 7--< F`�J - -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County State laws, and rules and regulations of the San Joaquin Local Health District. f .�i 1 (Signed).. f� f�� --------------------------------------------------- ------------------------------ Owner �. ( and/or Contractor) B'Y -----------------------------------•-------------------------------------------------------------------------•--•-(Title)--------------------------- ............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPL[C,ATfON ACCEPTED BY >' '�----'------ DATE--- � 1 REVIEWED BY - ------ --- DATE---- -----------•---------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------- DATE Iteraticf s and/or recommendations:------------�isg---:------- 0-�------- tilY.- = ------ :, " / --- -- Y i ----------- --------------- — L�—N •..... . y - cw- FINAL INSPECTION BY:. .-- Date---------------- - - Jx eax a/f' pu I'Ci�'x` //'14 r,-..-� S,f-�. S j� v/l. f�p ------ ---- -- S NpOQUIN LOCAL HEALTH DISTRICT 130 South American Street sowt Street 124 Sycamore Street �205We.t 9th Street !/ Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REV18tD 8.59 F.P.00.SM 6.60