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FOR OFFICE USE: .-!'"�"' - -_------`� -- APPLICATION FOR SANITATION PERMIT Permit No. �-- -- _... 5..._.�> . - ---- -------C-- - ___/-------- (Complete , -. lete in DuDate Issued ..//.�"��_.b ------- -----__-------_-_----..-. -_. - 'This Permit Expires 1 Year From Date Issued Application is hereby madelito the San Joaquin Local Health District for a'permit to construct and _install the work herein described. This application is made �n'�compliance with County Ordinance No. 549. x JOB ADDRESS AND LOGfATION---�/3�34--- ----......,------------------------------------------------•- -•---...._---------------—-----------.-.._..-------- Owner's Name r ':: PPhhoonnee.... - .. Y Address----------- ----------------------------- .7---------- Contractor's f Contractor's Name__.--._. Installation will serve: Res "encs [Apartment House:❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-- Number of bedrooms _--. .- Number of baths _I.--. Lot size .7- 1(1a- ---_------------------------- Wafer - -------------------------- Water Supply: Public Sys em V Community system ❑ Private ❑ Depth to Water Table Ate. ft. 40 Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0—Hardpan ❑ Previous Application Made-.. (If'ye s,date--------------------I No Z21" New Construction: Yes,2--No ❑ FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION I AND SPECIFICATIONS: jNo septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from*nearest well-Wit-----__Distance from foundation f ct !•+, i_,.Material ---------------------- ----------- Ca acit ------ Disposal Field: Distance from w�ell�za2-C----_DSize-----3xS�C�------_-•-Liquid depth-_.. ------------- p y--.�� - p stance from foundation.-l4-��-.Distance to nearest lot line.A............ [� NumbJP of lines------'-------- - --------------Length of each line----7� -----_ ---Width of trench--- Y. --------------------- n - v Type of filter material--Ro-C_�_----_-Depth of filter material_/K-.__-____---Total length----fid-----------------------•--_ �M � Seepage Pit: Distance to nearest well--- nL_______-D'sstance from foundation to nearest lot line__�_��_.------_ Numb. of pits._,a.-,. ----- --- g p Linin material__' G-_ Size: Diameter---- --xr----....De th------�-•••----•-------------- Cesspool. Distance from nearest well-----------------Distance from foundation-------------------.Lining material----------..-------------------------- U Ji. ❑ f ----------g gals.DI'iameter--------------------------------------De th_---------------_----_ _ ---- ----_ -_ --Li uid Ca acitY Privy: Distance from nearest well--.-----_---------------------------------------Distance from nearest building----------.__--_---_----__---------------. ❑ Distan IclIie to nearest lot line-------------------------------------------------- ----------------------------•-------•---------------------•---------------------------- 1 i • Remodeling and/or repairinyl g (describe)---------------------------------- -------------------------••-------------------------------....-..-_.----....-----••----•--------------------------- --------------------------------------------!ill-------------------'---------------------------------------._-....----------------------------------------------------------------------------------------------------------- ---------- --------------------- ........ ---------------------------------------•----........-------------------------------------------------------------------------------------------------------------------------- ------------------------------ iQ --- I hereby certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules d egulatio s of the San Joaquin Local Health District. Si ned I { 9 )--------- --- -- - --------��i---- ------ ----;-------- ------- - ------ -----------�--------------------------------------- -• ----- - --------(Owner and/or Contractor) By-------------------- ----- „-... . -- == ---------------------------------------------------•--------------------.-.(Title)-----------------•-- - (Plot plan, showing siz of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). dl; FOR DEPARTMENT USE ONLY ' // �'� 4_6---------------- APPLICATION ACCEPTED BY -__�_-- r .----- _--------_-_ DATE--- -___"-_- ---_ REVIEWEDBY-------------------- ----------------------------- -----------------------------------------------------•----------------- DATE------------•---•------•-•---------------•------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------' DATE Alterations and/or recommlendations---------------------------------------------------- --'== =_"_------------------•---- ------ -------------------- -- ----- -----•-----------------•-- ----- --------------------- ....--------�'----------------------------------------------------- = ----------------------------------------.-- --------------------------- ---------------------------------------------------- ------------------------------------------------..-------------------------------------------- FINAL INSPECTION BYI:. -Date---------- -- --------- ---r Gh SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantoco,California Tracy,California E6.9 REV{BED B-59 F,P.Co.1M 6.66