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r" FOR OFFICE USE: _ L�J�vv 1 APPLICATION FOR SANITATION, -- ------- � .�•-!J Permit No. ...f.-.� �•� . rRM "_/--------- (Complete in Duplicate) t � _ _ Date Issued ---------------6->�- _---._ _---._:.._._ This Permit Expires i Year From Date Issued j 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. ` JOB ADDRESS AND LOC TION - Phone ..3_ �' ' Owner's Name_ _ t_ .---'~• -z Address = i - ----------------------------•---.._...---....._-------------------- Contractor's' Name. l.. = ................ Phone------------------------------------ l Installation will serve: Residence ❑ Apartment House ❑ Co4ercial ❑ Trailer Court ❑ Motel ❑ Other R f LABOR Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -------------------------- CAMS All Water Supply: Public system ❑ omm it y 'sys ems❑�Private'R Depth to Water Table ; ft. pLrAr .. PKr a Character of-soil,to a depth of 3 feet: Sand ❑ I Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ E. Previous Application Made(1'fye dote= --- I No New Construction: Yes IS No ❑ FHA/VA: Yes ❑ No*R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted if public sewer is available within 200 feet.) Y �--___r-4 tan from foundation -Q.. _.....MateriaLP�_�_'.�AS7......C�l�1F w. s Septic Tank: No. of compartments-nce from nearest well PJ--- Di�t �iF $ _� Liquid depth____... -_ ____________Capacity..✓<.sS--� � ��S;ze 4 Disposal Field:' Distance from nearest well_ L_[Q___1Distance�from foundation...i-0.....-----Distance to nearest I Line ___________ Number of lines--------.;?—-------------------,Length of each line-----i__00--------------Width of trench- Type of filter material__Ke,-G.K-_--,DeP th}of .filter material-____1_q-+r------Total length----__�Q-_------------- -- - Seepage Pit: Distance to nearest'well--------------------_Distance"from foundation--------------------Distance to nearest lot line-------_-------- ❑Y Number of pits------- ------Lining materl� ------------Size: Diameter-----------------------Depth----------------•------------•-_ p Size: Diameter--------•---------------------------Depth='-==--�----- ----------•----------- Liquid Capacity ' gals. Cess ool: Distance from nearest well-------------- Did=from foundation._-_.______._.____.Linin material_-----.----.__-_:_-----_ ---------- ------------ --_-_ i Privy: Distance from nearest well________________,_..____.---.__----..------- ---Distance from nearest building..___.._________-.-____________-.---.--. r. _..,,. ❑ Distance to naarest; of line------- -- �- _. ----- --- Remodeling and/or.repairing'{descnbe� _ = ;---:-- ;.4== ---- a ►._: ------------------- --- ----------•--- t-- ------------------------------------------- -- --------- �I..+ k. !' 3 F ---------------------- ----------------------- ---------------------------------- - ---------- I;.hereby c_ertify at I h ve prepared this'applica#ion and that the work will be dens in accordance with San Joaquin County ordinances, S to n ry les and' re ti"s of the San Joaquin Local Health District. i S"• d_ -: --------- ------- - - -{Owner and/or Contractor) (S-9 } --- ------------------------- -'-------- - _ E +s e _ - ------= -- Title-==----= ----------------- ---d .� .- (Plot plan, showing izefof lot, location of system in relation to wells;'d,buildings,yetc.ca{be placed o reverse e). i FOR DEPARTMENT USE•'ONLY ` APPLICATkON` CCEPTEDs6 = �- =' .:_ - _ DATE. rf.'- IY------------------------ BY --------=----------------------'�"`--- -------------- DATE ------------------------------------------- REVIEWED BUILDING PERM17'ISSU'ED----------=--------------------- raw ai' DATE---_'"'.."�'�..�------.-._. Alterations and/or recommen ations:__ __- ----------- -- -----•---------• • •--_- ------ ---- ------ ------- A. !� - --------------------------•- . Date_ ' ff' FINAL INSPECTION 'BY:_+ `_. °�. �- ----------- Y / ----------------••------ 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 Tracy,California ES•9 REVIr E0 B•59 F.F.CO.2M 6.60