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FOR OFFICE USE: :-- :,� -------------- �- -------�C APPLICATIDN FOR SANITATION PERMIT Permit No. ..f.-53_03 --- -f - -- ----- ------• ----- -- ------- ----- -- (Complete in Duplicate) 7 ---------------------�-� -��L3�This'Permit Ex ires 1 Year From Date Issued Date Issued _._.� -.6_ -_-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. j This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_--- i a - .---- us-p/ 'v ^---- S` ------•----------------------• --•----------------------_- --------------- Owner's Name. -•-----••--- ----- Phone---------------_- -•------------ Address........... ---- --- Address-----...-- -J✓LrL�t�f Contractor's Name-------------_------CS-- ---- -- Phone. -------------- Installation will serve: Residence Ap rtment House ❑ Commercial ❑ Trailer Court ❑' Mofel •❑ Other ❑ Number of living units: _..1--_- Number of bedrooms .__ --- Number of baths __I......Lot size ._------ ...._- ----- Water Supply: Public system ❑ Community system ❑ private W Depth to Water Table s ft. y 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 ❑ ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �j /f Septic Tank: Distance from nearest well..r/{ /---Distance from foundation__._%.Q.r�`...Materi�l-...:L�c -C2Q -old No, of compartments...-___---- ' ..___f Size. /_..., .-- Liquid depth-..----�/.............Capacity...43.15T U_.. , \ Dis osal Field: Distance from nearest weil...�, _�-.... � P � Distance from foundation �[J...12'Dis#ante to nearest lot line_....-..�r�....._. Number of lines........... .. Len � ° •----------------�Length of each fine-------•--- ----fr_---.Width of trench-----•-•--- -.---- Type of filter material_. .-��I�•Uepth of filter material-------IX x ---------.Total longth-----------------=--15--a------------- `) 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--------------------------------------------------......................................Dis#ance from nearest building-----.----------------- Distance to nearest riot line ----------------------------------------------------• ---------------------------------------------- Remod ling and/or r pairing (describe):_.._.._..*.-----4JA Y--- ------- - • S O ----- /' y� #-..U.o..._.e� �j `f L ` I -- --- �-- -- ----�G.---__7�1,1.1 -----_7TH--•------------- --------- - i --------------------- ---- -- --- ---------------- -------------- ------------•--------- --•- ---------• 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 and regulations f the,San Joaquin Local Health District. (Signed)--- ----- � ---------}---------------- -_-__-(Owner and/or Contractor) �- 8Y: 9 -------------(Title)-------•------------------------------------ ----------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY •-•------------ DATE_..---- 7/` ,f " REVIEWEDBY-------------------------------------------------- --- ---•-------------------------------------------------------------- DATE----------- ------- ------ •-------- BUILDING PERMIT ISSUED--------------------------------------------------------------___---------------------------------- DATE----------------•-------------------------------•-•--------- Alterations and/or recammendations: ` = ------------------------------------------- -•=--------... .------------------------------------------------------------- ----- ------- --r--- ---- --- -•-------------------------- --------------------- •---- -------••••----------- --------- ------ ---------- --- r - _.-- - ---- — -- J--------------------------- ------------- - ------- - ---- -- - --- ---- --- 4 FINAL INSPECTION BY-_11,111 -- ---- ----- - ------ ------- ---------------- J Date------.. SAN JOAQUIN LOCAL HEALTH DISTRICT E 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REV15ED 9.59 F.P.0 C.7M 6.60