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FOR OFFI_C U E: <br /> APPLICATI0WFb'R SANITATION PERMITPermit No. <br /> s. <br /> (Complete in Duplicate) pate Issued <br /> _ _ ______ _ -------------------------- <br /> ----- -------- --- <br /> --------------- <br /> -- -------- -----_ This Permit Expires 1 Year From Date Issued <br /> ------------------ <br /> ---------------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor a in desgpe ." <br /> This application is made in compliance ith County Ordinance N . 549. €; <br /> JOB ADDRESS A ATI .. `�.---- - --------•-- ------- •------- <br /> 3 <br /> Owner's Name---'C% ------------------------ Phone... <br /> Address-------------,�-•- -----.----1`- •t------- ' ----- <br /> ----------•-------------•-------------- ----------••-•---------...................................... <br /> 6. ------ .-_ ` `.:._ Phone <br /> Contractor's Name------ --R-----"•--------- -- --•- - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size ------------------------•--------- •----------•------- <br /> Water Supply: Public system ❑ Community system [IPrivate.$ Depth to Watel; Table/,S,- f#• ✓ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F] Clay Loa ❑ Clay.❑ Adobe Hardpan ❑ <br /> r <br /> Previous Application Made: (If yes,date------____,___._.-1 No [I New Construe#ivn: Yes,� No ❑� FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i 4 <br /> (No septic tank or cesspool permitted if public ewer is available within 200 feet.) t I <br /> Septic T Distance from nearest well_'_______-__Dis}ante from foundation--- Z"_:__.___Mate rial__ �F-- -- - ---- -- <br /> J re ' <br /> Si,e----_-- --•---Liquid depth-_y_�� <br /> No. of compartments_,_=_,__.'f__.-___._ <br /> � - Capacity---;? <br /> ,rte f Ql_ Distance~to=nearest lot line.__.___.___. <br /> Disposal field: Distance from nearest well______ ._ _.-_._Distance from foundation___ <br /> Number of lines_____._ ___ Y- Length of each line/co_/_PO___g0 �h/idth of trench..______-.r7_$---------------- <br /> Type of filter material_ t ----Depth of,filter material__,-�- ---Total length_______ ••--------------� <br /> Seepage Distance to nearest well._)W....------Distanc om ou-dation__ Q=:. Distance to nearest lot line___., <br /> Number of pits____-__ '_____Lining material. _._ _ <br /> Size: Diameter- �?............Depth------/� <br /> Cesspool: Distance from nearest well----------------- from foundation------------ <br /> Lining material_.___ _-_____._____.-..___...____.. <br /> 4 ❑ <br /> Size: Diameter. <br /> ------------Depth---- ------------------------ ----- -�----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------- - ---------------Distance fro nearest building------------------------------------------ <br /> Y, _ . . f _ <br /> ❑ Distance to nearest lot line---------------•------- -----------•----- <br /> i ---------I----------- <br /> 'Remodeling and/or repairing describe -- ---------------------------------- <br /> ---------------------------•---------•------------------ <br /> ` <br /> ---------------------------------------------------- ----------------•-- --------•----------------------------•------------- <br /> S •------------------------- <br /> -------------------------------------------------------- ------ <br /> IIt ------------------------------------------------------------------------------------------------ ---------------------------- ------------------------ --•----------------------------------- -------------- <br /> I I hereby c rtify that I herulesnd <br /> ed this application and that the work will be done in accordance with San Joaquin County <br /> .ordinances, t aws, d egulatio of then Joaquin Local Health District. <br /> (Signed}__-- ss------ -- ----------- Owner and/or Contractor] <br /> -- ---- - -------<77 By:--------------------------------------------- -- <br /> w (Title}--:--- <br /> (Plot plan, showing size of lot, location o system in relation to wells uildings, etc-,}can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY { Z" 1 <br /> APPLICATION ACCEPTED BY----- � �' C7 n ----------------------------- --------------- - =- DATE - R�'V� <br /> --------------------------------- DATE.----- -------------------------------------•-------------- <br /> REVIEWEDBY---------------------------------------.._._.. ------------- ------------ -------- -DATE t <br /> BUILDINGPERMIT ISSUED------------------------------------------------------- -------------------------------•---t DATE <br /> Alterations and/or recommendations------------------ ------ ------- ----- ------------•------••-------------------_-..--.----------•-•----••-------••------------•---------------------•------ <br /> .Cx'T I _ fi�C '----- - --� <br /> ---------- <br /> CAI J1_a✓Il"T------L-l_ . �A-- 1-2._'_11�7/�CJ4..__.'7_D_.--- <br /> . ...... --------------------------------------------------------------------- <br /> t:► . <br /> K -- --------- ---- ---- <br /> FINAL INSPEtJJQN BY:. - -- ------- - --- -- ---------- Date------57/0­41-------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> w,.130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> k <br /> Stockton,Californiaodt Callfornia �` Manteca,California Tracy,California <br /> E6-9 REVISED 6.99 F-F-CD.2M <br />