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Permit No. _.. .. ��'_ ...!� - ------------ ------ _----------------___--- APPLICATION f-f7R SANITATION PERMIT (Complete in Duplicate) J - `] _-,.s p } Date Issued•-- ..� - ----------------------- __- _fI_ ___-___ rhis Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicat' n is_rnna a/in compliance with County Ordinan No. 549. ...............................V44EZS_SS_A= tigt�OC ...walolj. Owner's Name-- e-_-' -�' � .__ Phone.. .... Address................�7`f` ._/I%a ................................................•...- •-•--••-••-••----••--•--- Contractor's .Y,/)----�_ !Tt ��*� t--------------------------------------------- Phone.. - ! Installation will serve: Residence p�artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___(-__ Number of bedrooms __ Number of baths _1__-_ Lot size -------- ........ ............... I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4-10-dit. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.O_Hardpan ❑ Previous Application Made: llf yes,date____________________J No ❑ New Construction: Yes ❑ NOA FHA/VA: Yes ❑ No ❑. TYPE OF INSTALLATION AND SPECIFICATIONS: : (No septic tank or cesspool permitted if public s wer is available within 200 feet.) E Septic Tank: Distance from nearest well-At________--Distance from fours tion_1 ----------Material_-_--_�- ...............:.. ...... No. of compartments._ _______________Size _�� ` __,T._Liquid depth... °1_.________ Capacity...s�°`p Disposal Field: Distance from dearest well____----------Distance from foundation ._� ' Diitance to nearest lot line.-Z-0.... Number of lines.:.../------------ __:__Length of each ________.Width of trench---------a_5Z��__...... Type of filter mafierial- 1:. ____Depth of filter material______: '._..Total length------ .................:...... . Seepage Pit: Distance to nearest well___f _ ._.Distance from foundation_J.10..,.___.Di ante to nearest lot Number of pits_..-:�______________Lining material._12.__ ___ ---- Size: Diameter_____ «�_�__..Depth___-_�_V�r . .......... Cesspool: Distance from nearest well-----------------Distance.from foundation--------------------Lining material_____-_____________--__,._a.__..� ❑ Size: Diameter--------------------------------------Depth---------_--- ----------------------------------_Liquid Capacity---=---....................gals. Privy: Distance from nearest well__________________________ _____________________Distance from nearest building_`--------------------.-_-..__--. ------ .16 ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------.._-----------------------------•------ Remodeling and/or repairing (describe) ` --------•...............................•---------•........_...- ----------- .............................................................................. = - -- %------ ---- -•--- ----------••------••---•----_____--•----------------------------•-••------------------------•--_____-___----------•----------------------.....----•---•-- - _________________________________________________________________________________________________________ ______-_-____•_______________________-__________________ E _____________------------------------------------ __________________.._.____._....__._. .... t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulaiio s of the San Joaquin Local Health District. (Signed)... -� ��Yl ( Contractor) f L (Plot plan, showing size of lot, location of system in relation wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY !� APPLICATION ACCEPTED $Y J DATE / L-------------- r REVIEWEDBY-----------------------•-_-------------ye------------------------------• ------------F------------ ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED.. ----------- DATE------------------------------------------------------------- Atterations and/or recommendations:-------------- ----------------------------------------------•---•--•-----------_----------_----•-•----------_____--•--------------------------••----- '' .... - --- ----- ---------------------- --• ------•------------_- -•-----__-.....-_----•----------------------------- --- � .!� .. --------------------------------------------------------------------- ------------- -- -- 1 FINAL INSPECTION BY:...... - .......... Date--------------4,7- .. .- ...- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 134 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i EB 9 REVISED 8-99 pM 6-6E ATLAfi