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FOR OFFICE USE: R41'_/t1'�_r---------------------- ---------------------------------_------.--------------.- APPLICATION FOR SANITATION PERMIT Permit No. _...1 ..Cy.... 3 -------------------- ------------------------------------ (Complete in Duplicate) / ------------------------------------ This This Permit Expires 1 Year From Date Issued Date Issued ___-_ Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �T JOB ADDRESS AND LOCATION_.--- -----`` ,/ .S?? R _s��/..__.`--- C_, � -------------------------- Owner's Name----- .......... e ---------MMM------------------------------------------------------------------- Phone------------------------- -- Address................g"A0.....�._ � _l11 Contractor's Name---- :�- _....... .5, --------•-------•---•--- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____f_ Number of bedrooms _Z__ Number of baths _-/__ Lot size - ------------__________--_ Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table 440 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobx Hardpan ❑ Previous Application Made: (If yes,date------ -----------) No [ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well .__Distance from foundation-_/Q____-______.Materi9L____�,eelcl��---------------__..__. No. of compartments-_------------------ -S tf_.-tC_- 2.—.Liquid depth_-,O________________Capacity ��_. _ Size____ ___ __ `n Disposal Field: Distance from nearest well.//Qglf*,._.-Distance from foundation__,f'�/_______Distance to nearest lotjine. Number of lines__________________ _____________Length of each line_______ru0__ _________-Width of french____, -4w--- !v Type of filter material �.___, 0G,(e-------Depth of filter material- ,fr-/--........Total length------ /______________________ See a e Pit: Distance to nearest well---1�1D,e11e----Distance from foundation__fV.._--------Distance to nearest lot line_.t_-_________ Number of pits________ ___________Lining material .__.Size: Diameter-_ 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 building------------------------._-_.-----------.. ❑ Distance to nearest lot line=-----------------------------------------------•-•--•-------- ------------------------------------------------- --------------- - --- t Remodeling and/or repairing (describe):___-- {'_____ _ _ ------ _-___'06'a2/....... ( ____ ------------- t 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 la and rules gulations of the San Joaquin Local Health District. (Signed)----- _ e = weer and/or Contractor) IBy--------------------------------------------------------------------------------- -----(Title)------ (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ `---�-�:7�C -�-=-- --------------------------------- --------------------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE----------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------- -------•----•--------•--•--•- DATE---------------- ----------------- Alterations and/or recommendations:------------- ----------------------------------------- ------------------------------•------------------------------------------------- 33 -------------------------------------------- -------------------- ------------------ ------------------------------------------------------------------- -•--- -------------•-- ._.._..----------------------------------------........ -----------------------------------------•--------------------•------------ --•--•------------------------------------- //++ �' FINAL INSPECTION BY:- -L' c Z Date T SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVISED 6.59 F.P.00.2M 6.60