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--------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ,r-,� (Complete in Duplicate) Date Issued _ Y 0 - -------------------------------------------------------- This Permit Ex ires 1 Year From Date Issued i Application is hereby made to the San ;.loaquin 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. SC� JOB ADDRESS AND LO PATIO^N1r : t11J l C CJ--0 � M1ksr�� ------------- Owner's Name---------------�. -m-lid-----------5....(_i-_A_ _ _ ------------_-- Phone----------------------------------- Address----------r 1_ __` o x-----IC��_ _ -w:�?. Contractor's Name----._Q-W_N.= --------- .-------. Phone----------------------------------- Installation E�RaQ� Installation will serve: Residence [J' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ NppITsan/ Number of living units: _1.-___ Number of bedrooms-25___- Number of baths t----- Lo;-size /'I��+ti'i�.- -_ ------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table YO_ ft. Character of soil toa depth'of 3-feet:- 'Sand ❑ 'Grave l'❑- Sandy" L.oam E],-Clay Loam Clay E] Adobe C] Hardpan f�J' Previous Application=' pplication Made: (If yes,date.__Y__ .;r' l No New Construction: Yes No ❑ FHANA: Yes ❑ No-M_� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) y Septic ank: Distance from nearest well__—.._�____Distanc () p from foundation- ------ te�i I-----CO- I_C _FFETT__ Noof comportments_.._. . --______.._Size--- --------h_X_ Liquid depth__ ---- Capacity---- Disposal Field: Distance from nearest ------Distance from foundation__/O----------,Distance to nearest lot line_______________ Number of'lines___ ______ __________ ___________Length of each line____ _.. __._.Width of trench-_----- - Type of filter material _ OCr-,_-_Depth of filter material------- ________._Total length________,__) ___________________ Seepage Pit: Distance to nearest we L11.<5_._0 ___Distanc from foundation_-_.�Q_...._,p,Dist nee t nearest lot line______._. Number of pits-- l------------Lining material'�0CA------Size: Di;ameter_T Cesspool: Distan fee om nearest well---------_-------Distance from fou dation_._----_____--_-_--.Lining'material______________,.,.------,_.____._---- Size: Diame#er--------------- ' '_De th_----------------------___.-- �_ Li uid�Ca acit `` ❑ r p q p y----------------------------g"als. Privy: Distance from nearest well---------------------------------------_---------Distance' from nearest building__-_-____------____-----______.___.._____- ❑ _,e— Distance to nearestjot•line---------�`'�...--- - -------- - ---------------`-----------•------ I------------------ -------------------------------- � I Remodeling and/or repairingscri [debe)=------------------=-------------------------- E-=------------ - ------------------------------- ----- ----------------------------------------------------------------------------------------------------•-------------- ------------------------------- -------------------------------------------------------- ------ --------------------•----------------------------------•------------------------------------------------------------------ ----------------- ------ ---------------------------------------------------------- --- ----------------------------=---------------- ----------------------------------------------------------------------------- �_ I hereby certify that I have prepared this application and that the work will be' done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local.Health.District.I (Signed)- ;( lJ!:•✓lyl 7 - "'------- Owner and/or Contractor --I-•--._Title (Plot plan, showing site of lotjocation of system in relation to wells, buildings, etc.l can be placed on reverse side): t I _ FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY!------ --------------------- ---------------s-----------------f--------- DATE---------J� ---42-- --------------------- REVIEWED BY ----------------- ) ------------f--------• DATE-------------------------------------------- BUILDING PERMIT ISSUED------1--------------------------------------------------------------- ----------- DATE------------------ ------------- Alterations and/or recommendations:------- ------ --- -------------------------------------------I------------------------------------------=--------------------------------------•------------- ------------------------ � �°j�� R ----- -------- ------ ---------••----------------------- -------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- X11 I! FINAL INSPECTI ! j Date---- --- -__`-.P J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3••63 i,p.CD. -