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FOR OFFICE USE: t --- -------------- APPLICATION FOR SANITATIQN PERMIT Permit No, ---------------------------------------------------------- - (Complete in Duplicate) Date Issued ------------------------------------_----------------.--- This Permit Expires 1 Year From Date Issued Applica+ion 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 LO ATION-..._-- �_ Q "- �'� Owner's Name_____________ _ C Phone.__ _. ---�-- ---- - -- --- --------- -- --- -------------- -------r.------ ----- l� 9... Address_____________ -� .---- -----.... a �----------- --- ----- Contractor's Name---------------------- -------------------------------------c -- ---, •----•---------- Phone................................... Installation will serve: Residence F] Apartment House [3Commercial `frailer Court ❑ Motel ❑ ther ❑ Number of living units: -__-__. Number of bedrooms ________ Number of baths ________ Lot size .....la_ 16�_ �-__..... Water Supply: Public system E] Community system ElPrivate-❑ Depth to Wafter Table -------- ft. Ir- ' x reg Character of soil to a depth of 3 feet: Sand n Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date___________________) No JR�' New Construction: YesN""No ❑ FHANA: Yes ❑ No W TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) r u h Septic Tank: Distance from nearest wall___dr_.�h'1[titDistance�from fPundaiionlP..�li_lA...Materigi-------�_�_�_[_r_________ f No. of compartments-------- _ �___�Size._"3__ _ ��___Liquid depth__--_--�--------------Capacity_____ _ [r Disposal Field: Distance from nearest welL__".."Distance from foundation-/Q__ -ANx__Distance to nearest lot line___.?__-_%t_1_A Length of each line_____ Number of lines--------------(______ g Width of trench.____-_ Type of filter material___ Depth of filter material___ Total length______ 30---_-- Seepage Pit: Distance to nearest well----------------------Distance from foundation______...___.....__.Distance to nearest lot line___.-._____.__.__ ❑ Number of pits----------------------Lining material..-.-------------------Size: Diameter-------.-------.-------Depth--------------------------------- Cesspool: Distance from nearest well-------------____Distance from foundation--------------------Lining material_____.._______.__________________.___ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------.__.-------_---_-___._-_____. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------- ------ _._.---------------- Remodeling and/or repairin describe}:____ _______________ _____ __ _ _______C___ ______ ----------- -�-Q-------------------------------------- ---------7 - �a - ---'-�- -•-- --- •----- --- -------- --------- ------ - --- - ---- ---- -------- -- - ---- ---------------------------------------------------------------------------------------------.------- ----------------------------•------------------ --•-•-----------------------•-•-•--------------------------•---------------•-------------•-•-------------•-----------------------•--•---------------- Q I hereby certify that I have prepared this application and that the work ill be done in accordance with San Joaquin County ordinances, State laws, and rules d regulations of San Joaquin L al aIfh District. (Signed)------y, — _ Owner and/or Contractor} By:----------------------------------------------------...--------------------------------------------------------------------------------)Title) (Piot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------- r ---- DATE....----•- REVIEWEDBY--------------------------------------------- ---- ----------------------------------------------------•---- ----•---..._ DATE----------------------•------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- 4-p- 9 — � 4"1H---- x�Y -u 4-`-------R ........ t3� EO,tC 6°R---------3a------- rte?.------ -----e-F-----`W - -------------------------------------------------------------- -----------------54FP7i4--------r-�}NK----© K- `r� --------------------------------------------------------------------------------------------------- _ ----------- ------------ ---------------- ---- ---------------- - ---------------------------- ---------------- UI_BY _____-- - f ------- - ------------------------------ FINAL INSPEC440Date___.....__ =�_ "!�/__ 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 c ES-9 NEvioco 8-54 F.P.Ca.'aM 6-60 E�