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FOR OFFICE US ---------- -------------" _---_-"_--."_. APPLICATION FOR SANITATION PERMIT Permit No. .. ..� ------------------ ---""-"" (Complete in Duplicate) -- --------- This Permit Expires 1 Year From Date Date Issued a 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. Iv �Q JOB ADDRESS AND LOCATION �� � Cy 6� "�` �� c ---- Owner's Name........ ... .. . ---------- ----- .. hone- 4 7-- -- = �7t�rf Address !;?-- --- ----- -. _ '�. -- ---------------•-------------------------------- •- - ..._..... Contractor's Name----- . _}•�41 Installation will serve: Residenc Apartment House ❑, Commercial ❑ Trailer Court ❑ MotelOther ❑ Number of living units: .1---- Number of bedrooms :,Z_. Number of baths I... Lot size _ � �SJ'j Cs Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table.S�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [$j Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date. -- - ---------------- No New Construction: Yes g No [IFHA/VA: Yeso No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e Septic Tank: Distance from nearest well'Zoo---__Distance from foundation.,IQ _ -..-._._-"-.Material._- - ►+`�'''� No. of compartments._-__-_"-_----------------- Size__ 7P ` �o_ DtLiquid depth-SZ---------------CapacityQQ "- ---__ Disposal Field: Distance from nearest weII.n_'-_Distance from foundatin. ` Q_...._.._.Distance to nearest lot line..-_ -- Number of lines.- 2 _____________•Length of each line--- "_._-_..._----_._.Width of trench."_,!.4.�.__-_-"__.--___•__. Type of filter material_.�p_L°-.----__Depth of filter material--_-. -r�_-.---Total length___. f�.___.._. Seepage Pit: Distance to nearest welL_IVS-0-------Distance f m foundatioV. �� �J-_.__. Dfance to nearest lot line.............".. Number of pits-.Cf -C��__Lining material-__ 116.0 Diameter----- -----......----Depth-_oZ..�--------------------- esspool: Distance from nearest well-----------------Distance from foundation--------------- material---------------------... ❑ Size: Diameter------------------------------------•-Depth----------- •------ - - ---- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nea�st well---------------------"--------.------------------Distance from nearest building. Distance to nearest lot line--------- " - ----- Remodeling and/or repairing (describe):"_-___-_ -. -- - --- ----------------------------------------------------------------- ----------- -- ------- - ----------------- -_- -"--"- -------- - ---- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State�Ilaws, dd ules add regulations of the an Joaquin Local Health District. (Signed) - `.._.._.��s --------------------<_69� ©- ------(Owner and/or Contractor) By: ---•----- ----------------------- --• -- - - - --------•-(Title)------------"---------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - - - -- --- ---- ----- -_--- DATE.._..._/. -. / REVIEWED BY. -----------------------------------------------------------••-------- DATE........................................................... BUILDING PERMIT ISSUED___.__._"----------------------------------------------------- --------------------------------------- DATE Alterations and/or recommendations:---------- ---------------------- ----------"-"-""_ .---.----.---.-- --- ---- -•------ --••--......---•-- li�- 2 --- -- ----------- ................. Gs--�a ---- FINAL INSPECTION BY:--- --- -- - --•-- --- -------------------------- Date...........S��- --�v-'-- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California E9-9 REVI6ED 6.59 F.P.DD.2M 6.60 Tracy,California