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FOR OFFICE USE r { Permit No. -•'!•• fc�131�_ ----.-.--9 ,cam^--� ----w-- �• s r;�==��. : _. APPLICATION FOR SANITATION PERMIT ----- I (Complete in Duplicate) Date Issued-------------- --_.---.-------_---.._' - This Permit Expires 1 Year From Date Issued %'A Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r, - This applicbtion is made in compliance with County Ordinance No 549' . n 1 ". .!�} at, A• �"^"'...moi` / -_-_•- ----- • - _•--• --------------•-...—s....---__.-._....--..-... JOB ADDRESS AND LO TION1 ..' ��l'i= �.. ,.---------------- r ' ------•--. - Phone._- _-.---•----••--------•- Owners Name. // �. i1.-.--• . -e ___ l If. ---•-•-•-• ...................... --•-------------•----•---- ------•-•----------•-- Address. r i� 15 a'` �' "`'>- ................... ti_......._........_... Name.. ••• r -------------------------------------- Contractor's �:1 ' Phone. i - Ql _e..... Installation will serve:' Residence ErApartment House ❑ Commercial. E] Trailer Court ❑ Motel ❑ Oth r[3 Number of livingunits: .-__. Number of bedroo M� _ . r>}s-. _-._ Numbt3f�of baths/-.y_`Lot-size _-�p��_,�._..1-��--��.�.�............:......... Water Supply: Public system ❑ Community system)❑ Private [6]!Deptht6 Water Table i Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam}❑ Clay Loam El Clay El Adobe j �Iardpan C1: Previous Application Made: (if yes,date--------------------)' No jig New Construe#ion: Yes No E] FHA/VA: Yes ❑�'No [I 'I TYPE OF INSTALLATION.AND_SP.ECIFICATiONS:-n F--F- -- �- (No septic tank 0,cesspool permi+fed-if public-sewer is avada-ble-.within 200feet.) -`I0----._Distance/from foundation--/D-_-.--.._- Material :._ l'...................... Septic Tank: Distance from nearest well__ . Q� No. of compartments---------a .-.-_-_ iquidepth ------------•-Capacity.. ; Disposal Field: Distance from nearestwell--- C1�-_�enath offrom each I ne7� �� P� � �dth ofttre nearest h `';I`�------------------ Number,of lines.-.-__ 9 i r Type ('filter material,/—/,e-1049 Depth of filter material---6 _ :__.Total length___- _�!_ ........_________________ 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation..-_...:..__:......D�stance to nearest lot line_-.-__-..._.-.-_. ❑ Number of pitsR---------------------Lining material. Size: Diameter Depth :.. \ p e th------------------------------------------------fndafiion �-----.Lining material-- Gy �- n -'Liquid Capacity---------- ------=---------gals. 1 Cess❑ool: DZea D$meter nearest well--------------- Distance from fou --- -- ---- --- -D Privy: Distance from'nearest--well-- -----------=:-R__------------------------- Distance from newest building._------....---._....---_--------...-:-,-- ❑ Dis#ante to nearest lot line--------------- -...-- ,:-----•-- - ------------------------------------------------------ 0 ---------------------------•---•- ..------- . - ,. r - � Remodeling and/or repairing (describe): J! "�__-�'� . ••..----•---••.�'-- _• ..... I ...................... If ,.. -•------ x ! hereby certify that I have prepared-this•application-and-tha+ the-work-will-6e-done-in-•accoFdance-wi+h�� n Joaquin uin Coun _ +Y ordinances, State laws, nd rules and :regulations of the San Joaquin Local Health District. " Signed) � I1.--r..-, --- -------- ( / an act or C or --------------- i • - -lam ---------------- (r+lel1 BY� ........................_...... (Plot plan, showing size of lot, Iota+lion ystem in relation to wells, buildings, etc., can be placed ori--reverse side): ( FOR DEP itTlv�N_. SE_ONLY_, •A I I 6 i APPLICATION ACCEPTED BY----- ....... r -------------- Q `a`'? = REVIEWEDBY--------------------------- ------------------- --•--------------------- DATE--------------------------------------------L-------------- BUILDING PERMIT ISSUED-----------;---------------- Df4TE. = Alterations and/or recommendations:---------------------- •----------- --------------•-••-----------•----...--------....................................------- ---------------------------- .......................... ...................................................... ---- ---- ----- --------------------- - FINAL II�SP1rCTION BY------------------------- ---- ------------- ------- Da+e---•-----=---- -•-`��---= ----- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak ST►eet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 OXVISED 8-S9 EM 5.61 ASLA9