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FOR OF"C US ----------- Permit ) f 30 ------ - - --- --- APPLICATION FOR SANITATION PERMIT No. ___________________ __ ----------------- - ---- ------- -------------------- (Complete in'Duplicate) 1 p ___________________________ This Permit Expires 1 Year From Date Issued v Date Issued __ Application is hereby made to the San Joaquin Local Health District for a permit to constrd(�i stall the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION:____3.350_____--------- ___•,�"`n�-j�E!--I----___..__._ Owner's Name- - ----------�-�------lq L�-- ---•--------_s_ 1�-T4-------------------------------------- ---------- Phon , Address--- 3-J�--s--------- Q-=------_-- s - = =_= ------------ .:..... Contractor's Name---- � l _ I p I�t #------�-----PRIG------HV___,� _.. .. Phone. Installation will serve:' ,Residence 6Apartmeri# House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ Number of living units: __ -____ umber of bedrooms 5- Number of a+hs -----__, Lot size X------/_7��------------------ Water Supply: Publicsyste ommurii+y system E] Private Depth to Water Table ___-__-_ ft. ' Character of soil to a;depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A--Aardpan ❑ Previous Application Made: (If yes,date`V_Q _"n)_No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECACATIONT:�, ji(.'`-3- (Na septic tank or ecesspeol(permitted'i4 public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------ Distance-from foundation________ --------Material------------------------------------------------- ❑ No. of compartme ts----------- ---------- ? Size i,......� : '•-.Liquid depth Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation----------------.\.Distance to nearest lot line___________-___-_ ❑ Nu`rnber of lines.... f_Length of each line---------- -----•` --Width.of trench----------------------------------- rr� 11 Type of filter material-- -------------------- -Depth of filter material-------------------- ___= -N/__________-__ otal length------------------------------------------ W See Distance to neo _ _,.y P 9 , rest well___1C�®__ ___Distance from foundation__ __ _________.Dis#ante to nearest lot line____ �___� w Number of its_-_-__j______________Linin material_-_-__OAK._-Size: Diameter______ ` P 9 --=------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 buildin -------------------------.----__--._. ❑ - Distance to nearest.lot line_________________________ ___ ' -� _____________________________________________________ j_-_________._______--___________________---_______----------------------------- g g ------------------------------------------------------------ --- T Remodeling and/or re (describe):__�______________________. _ ________________-_ • Y ; l -------------•------•-•..........-------i•--•-----------------•-----------------------•---------------------------------•-----------------------•----•-•----•---------------------------•------------------------------------ i 1 i I 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. t (Signed)__-- -__--- ------•-------------------------- - �_4_,--____- ._"-_ (Owner and/or Contractor) r r� e+ By: :-----------------{Title) `--------------------- ---- - ----------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.;can,be placed on-reverse side). €"1 f FOR DEPARTMENT USE ONLY - DATE-------/_ -7/.Q_�---_ - �!i_!---- APPLICATiOI�E ACCEPTEQ BY-------. r_�_:-�' -----------�------------------------------------ -- �/ REVIEWEDBY '----------------------------------------------- ----•------------------------------------------- DATE ;-"-------- kBUILDING PERMIT ISSUED-----------------------------------------------------------------------•--------•--------------------- DATE------------------------------------------------ -1--- Alterations and/or recommendations:--------_-------_------------------------------------------------------------------------------------------ i � ----- - �_-� �-�----- E - -..---- ... 1 r ----------------------=------- -- �.�-e --------3--`.... - ----------------------------------------------------- ----- - -+ --�-----�*..... a- '�------ fa----- • tv --- ---•---- •-� y� � ._ - - / IN L INSPEC I N �e� Date .-• � G 2 ------------------------- -- �� y/ � - SAN JO7A61rUILOCAL HEALTH DISTRICT t30 South American Street 'fid '� �S 300 Wast Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Ca Ifornia Manteca,California Tracy,California EE-9 REVISED 5-69 r.PXO.7M 6-60