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FOR OFFICE USE: -------------------= tw ----�-��-�s_ _�._____ ,_� v---- APPLICATION FOR SANITATION PERMIT Permit No. _.1_3.U-.`{-._-.- t --- l ---- -- -'---- (Complete in Duplicate) t $ --------------------'---- / w_. - -This Permit-Ex o ires 1 Year, From Date Issued Date Issued --- ----------------- _ �f -- 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 OCATION___,:;2ZaQ__. Owner's Name--------- ,. /- �lt (/ Phone..................------•--- l�� Q a7�C f �., Address__------ FI(r0./- ---ica.-1�_ �C r =� ' ' i Contractor's Name.......... ----------------•-----••--•-------_---.--------- •------ Phone................................... Installation will serve: Residence 2"Apartment House ❑ Commercial ❑ Trailer Court '❑ Motel ❑ Other ❑ i I 1 01 Number of living units: __' ___ Number of bedrooms. Number of baths�� Lot..size _..�_ __l ____________________________ Water Supply: Public system[Community system ❑.. Priva-te ❑ Depth to Water Table,'Kopf}- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand 4-Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No []jNew Construction: Yes gKlTo ❑ FHA/VA: Yes_ WR-1^No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance'from nearest well__ -- Distance from foundation____lo____-_-Ma�rial____�__C!�f'k No. of compartments:=__Z____----------SizeX4�__ Q(Q-------.Liquid de th_- ( 1 Capacity__ i ----- Disposal ield: Distance from nearest well-____""`______Distance'from foundation---h----_-----Distance to nearest lot line.._______ Number of lines------,f?....__1 Length of each line__��____ h Width of trench__/_2."___�_ _ Type of filter mate ial___�, _ � Depth of filter material_____,_____-_'_Total length_____4.-10___ _______________ _ ._Size: Diame .Distanlinel Seepag it; Distance to nearest well____________ ________Distance fro foundation____. to nearest lot ___�� __-_____ V} . Number of pits----- s +-----------Linin g material___-, 4X ------------Depth-- ------------- Cesspool: Distance from nearest well.___--_______.!Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter------ p:'=- - - -------- Depth------------------=----------------- ------Liquid Capacity gals. Privy: Distance from nearest well_,_______________+...__-----____--..-.--___.-:.._Distance from nearest building-._________________..____________-._____-. ❑ .. .. .�, }-- - Distance to nearest lot line"------ -----------.-•---- ---------------------------------------_ ...----------------•--------------•--------------•-------------�•-- -- Remocleiing and/or repairing (describe):------- , :_- ------- ------•• ---___---_-_----_- -------------------------•••---------------------------------•------••---•----•----------------------------------------------- \` ------------- v ------------------••------•----------------------------------------•_.---•----------:--•------------ ---- -----------------------------------•----------------------------------•---•----•-----------•--------•--------•------------• ---------------------------------- 1=here6y certify that I have prepared this application:and-that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru s and regulations of the San Joaquin Local Health-District. (Signed) -- ------ (Owaer—ae�d�� Contractor). By:---------------•---=---------------='-=-----------=--=----------- AlI - -- ------(Title) (Plot plan, showing size of lot, location of syste relation to wells,-buildings, etc., can be placed On reverse side). FOR DEPARTMENT USE ONLY I , APPLICATION ACCEPTED � BY f � � ' t ---------•--------------- DATE----- REVIEWEDBY ----------------------------------------•----------------•----------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------- Alterations and/or recommendations:------------- --------------= ` ___-------------•-•-••-------------------------------------••--------- -•-------------___-----------••----------__.---•-- ----------------------------•---------------------•--•--•--- = R _ _ _-._•..yQ.t•__ .__ ___________________________________,,...----------------------- ---------------- ----------------- - _ _________________________________________________________________________________________ __________________________________________________________________________________ FINAL 'INSPECTION -BY:--- ; ' 1 ---------- +--------------- --- Date---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT _ 3 \� * 1 l.� �4,wsi ash -.N � 130 South American Street 300 West Oak Street ;; a 124 Sycamore,Street� � � 205 West 9th Street Stockton,California Lodi,California �.; Manteca,California v ' Tracy,California EE-9 REVISED 6-99 F.P.c O.ZM 6.60 a L, 5 '