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APPLICATION F(,. _:SANITATION PERMIT Permit No. ------ LL_ ) (Complete in Duplicate { Date Issued Application 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. 2------ - �-i ------�--�- ---JOB ADDRESS AND LOCATION_- lI-�-- - --_ -------- --�--- '-------------------- --I Owner's Name ---- t4As-------- --------- 1\1"------- Phone --- LTo Address---------------�44Q---------Q - - ----------------------------------------------------: ------------=------------------------•---•-------------------•--•------------ I Contractor's Name_O4~JR-9---..--ON MA-�'�K------ �-r----- ;M ----D1 --kM- INF b--------------------------------• i Installation will server Residence Apartment House ❑ Commercial ❑ /s,W41, � r Court � Motel ❑ Other ❑ Number of living units: _.___ mber of bedrooms __+` --------__ Number oDfeb+hhteroTable _ _.{ �---�---��------ Wafer Supply: Public system Community system ❑ 'Private ❑ p.ft. Character of soil to a depth of 3 feet:' Sand ❑ "Gravel ❑ Sandy Loam -O',* Clay Loam ❑ Cla ❑ Adobe Hardpan ❑ 4 Previous Application Made: Yes. ❑ No New. Construction: Yes ❑ No FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + r (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) m - n 1®-------- y1stante ri:al_� i _ S --------- No. Tek: Distance from nearest well-_jV0XDistance from foundation________. No. of compartments ------�^'-------- Size ----------------------� Liquid depth---- ---------- Capacity. -•---.9- - -- ----• Disposal Field: Distance from nearest we from foundation-___- ., to nearest lot line _____. Ner of lines-_- C ' T ume' of filter material.___ _ Q0 De fh of filter material13�_____ 1_-':-- .Total lenge ------ `! ______ Length of each line____-5_0-_-� Width.. of french r Distance to�riearest lot line_________________ # Seepage Pit: Distance #o nearest well_______+______Distance from foundation_____________. Number of pits ----------------------- Lining material ---------- --------,i e: D ameter----•---------------.Depth --- ----------------:---------- Distance from foundat.ion_______.__...----__..Lining material _____________________________________. Cesspool: Distance from nearesf well__ t —_�- _ ,.,�,,,,r. Size: Diameter – Depth --------------=-----Liquids Capacity ---------------------------- gals. \: Priv Distance from nearest well ------------------- -------- ------. ------Distance from nearest building------_-----------_--------------------:-. ❑ -..Distance to nearest lot line_ ---------------- -------------=------ ---------=--=----=----------------------- --=-------------------------------------------------- Remodeling and/or repairing(describel------------------------------------- ,-------------------------------------------------------------- :---•-----------------------•-- = ----------`----------=----------------------- - ---------------------------------------•--------------=--::-, --------------------------- r----------------------- -, -----------------------------•------- -------------- = - :� = _ _ L--------_-------•------------.-•--------------------------------------•---------- ----' t I hereby certify that I have.. pared this' application and that the work will be done% in accordance with San Joaquin County ordinances, Stat aws, and rules a d u ati ns of the San Joaquin Local Health District. (Signed) ----------- ----------------------------------------------------------------°-------------- ----(Owner and/or Contractor) ` tie (Plot plan, showing size o lot, location of yst a mn:relation to wells, buildings, etc., can be placed onor:, verse side). FOR DEPARTMENT USE ONLYf� i. APPLICATION ACCEPTED BY -------- .R - = - ---------- =---------------------- DATE-----" 5 ---•--------------- �al REVIEWEDBY-----------------------------_--------- ---- ---- ---I----------------------------------------�'------------------ DATE ==---------------... ---------= BUILDING PERMIT ISSUED__. -------- `--------------------- --------------------�—=_i_..- DATE ------- ----------------------------------------------------------------------------------- .... i. Alterations and/or recommendations:-------t/V-Ds /�_T_ 1� r-fflh%-----3�C � °'�"�" K'� .... - -----------------•--- ------------------------------------------------ :-_----= ----------- ----------------------------- 2 --------- I ------------------------------------ ®r FINAL INS ---- ---------------- Date --__` .5- -----------------------•--•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revises 1-57 FY120-