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FOR OFFICE*US �--- -------------------------- APPLICATION FOR SANITATION PERMIT r qq p, �t Permit No. .__.C..:3_�._!_._S_ . .� . {Complete in Duplicate) Date.issued --- ----------------� ---- This permit Expires 9 Year From Date Issued Application is hereby made theanJoaquin L r I Health Dist t f'for a permit to construct and install the work herein described. This application is made-in compliance with County Ordinance 549. ` JOB ADDRESS A SAT! N__ -- e ' P ' a (. - ---------------------------- Owners Nam -- ----. /�(„f *�` r ' •--------------------- I e .' Address------__..._ ;7 A V,C R - -- ---------- -------•-----------f-�-------------•--- Contractor's Name _!� � : i) r Ph( .......�� r.... K Installation will serve: Residence �- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths j_._. Lot size .?_52r- -XV- ------------_____________ Water Supply: Public system Community system ❑� Private ❑ Depth to Water Tiable.SV_ ft. Character of soil to'a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [j rClay ❑ Adobe,K Hardpan ❑ Previous Application Made: (If yes,date...........:........) No ❑ Now Construction: Yes ❑ No ❑" FHA/VA: Yes ❑ No ❑ t . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200'.feet.) € p , i�_Distance from foundation-_/ __.M tetiah. �,pai Septie Tank: Distance fromnearest w _ ze__ __ __ �_Liquid depth- -_}--. Q- No. of compartments--- Disposal om artments_______________ Disposal Field: Distance from nearest'well-A/iO'A/a Distance from foundation__/Q___.____-Distance to nearest lot lire_ _____________ Number of fines----� 'L�__i �,__.__:Length of each fine= ._ —% Width of french., �------------_------- p 7t...-- -Type of filter material--- of filter material___�_�_____________Total length____.._. �___._________...________. _ w [� _r Seepage Pit: Dis#ante to nearest well-_ _. O _(�,__,Distance,�roni foundation... is nce to nearest lot line_rr__±_____-__-_ Number of pits__ -:-------Lining materia€.-____EQ -----Size: Diameter_______________ _ Cesspool: Distance from nearest wall--------_ 'Dist ance from foundation_-------------------Lining material____--___________--.________--._ ❑ Size: Diameter-------------------------------------_Depth--------------------------------------------------Liquid Capacity_------------------------gals. Privy: Distance from nearest well---- ______________ ____________________-________.Distance from .nearest building_____-__________----_ ❑ Distance to nearest lot line" _____________ta ----------------------• ---------•----------•--------------------•-------------------------------- Remodeling and/or repairing (describe):----------- ------------•--------------- ti. ------------------------ __________________----------------- _____•__ ____ _ ________-_____________---____________. -____S_____-_. __ :-----_-------- _ t --------------------------------------_______________________________________ - ___ ________.________________--____--___.-___-__-____________--.____.__.__---_ I hereby cert! t I have prepared this pplica 'on and that the work rk will'be clone in accordance with San Joaquin County ordinances, State law , an les nd re la ns of a San Joaquin Lo Health District. [Signed)--------------- E Q - (Owner and/or Contractor Plot plan, showing size of lot Iota ton of in rely By:------------------------------------------- ----- - --- ------(Title)-------------- ( P 9 � y ton to wells, buildings, etc_, can be placed on reverse side). w WR DEPART ENT USE ONLY APPLICATION ACCEPTED BY_-- - ---------------------------------------- DATE-------- - --------- REVIEWED BY --- ------------ DATE---------- ---------------------- UILDIN PERMIT ISSUED------------------------------------------------------------—---------- --•---------------------.. DATE------------ -- - --- �----------------•---�-- Alterations and/or recommendations___ ______________ y = s `-- '- --------------------- �,� ----------------------------------------------=---------•---------------------------...------------------------------------- --------------------------------------- ------ ------------------- FINAL INSPECTION BY::.. ---------- ry Date------ ------------ SAN •--------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 20S Weft 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REV16E0 6.59 F.P.CO.2M 6.60