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FOR OFFIC USE: --- ------ - -- --------------------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No...�__...._ .a --------------------------- ----------------------------- (Complete in Duplicl ts) -------------- ---------------------- ---- _-.___._:.__ This Perrnit Expires 1.Year Froin Date Issued Date Issued .----•-../__�... �� 4 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. JOBADDRESS A LOCATION - ---------------------------------------------------------•....---.-...._.------------------ ---'z---------- Owner's Name ---x_ y �i-� Phone Address ----------------------- -•--- r ------------------------------------------------------ I— --------------------------------------- Contractor's - --------------------------------------------- Contractor's Name ----------- _---,eg-a._.____._. Phone.._. ................ Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: I--- Number of bedrooms Number of baths Z... Lot size -------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 211-iardpan ❑ Previous Application Made: (If yes, date____________________) No P" New Construction: Yes RR—No ❑ FHA/VA: Yes�S---No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f � i Septic Tank: Distance from nearest welly____Distance �from foundation._-_/,0_._..___.Material ___--(�________ ---------- No. of compartments ----- �__:___._____-_-Size_1f.%.r.__>�jx xk0. Liquid depth ------- 3er ______________ Capacity__/,4_0_47-__.__. p -- from foundation____f_�____.Distance to nearest lot ----------- Numberline --- , Disposal Field: of lines eares� well -41P149 Length of each line _____�4'___-___-__._.Width of trench_____ __________ __________ Type of filter material_X_� Depth of filter material___-/...._ Total length ----- I_VQ_-____________________._ Seepage it: Distance to nearest welLZIP10. .....Distance from foundation ----- 1Q_ ------ Distance to nearest lot line__..'._ !.... Q I Number of pits_-__�_------------ Lining material_____ / AV41 .jSize: Diameter____.,_ �._+.__Depth____-IAle_____`________ Cesspool: Distance from nearest we1L________________Distance from foundation_ ---________..__....Lining material _____._..__.____________________.___. ❑ Size: Diameter --I:------------------------- --Depth----------------- Liquid Capacity --------------------- •------ gals, Privy: Distance from nearest well _-_---------- _----------------------------------- Distance.from nearest building ________.______._____________._.______._. ❑ Distance to neaiest-lot line-- ----------------------------- --------------------------------•------ ------------------------------------------------------------------ ------ ... ... Remodeling and/or repairing (describe):-------- ------- ------ ----•-------------------•--••-------•------------------------ d 0. wI hereby certify, that 1 have prepared this application and that the work will be done in accordance with San. -Joaquin County ordinances, State las, and rules and regulations of the San Joaquin Local Health District." (Signed)---- -- �7--------�/zl�7-------------------- ----- - ---------------------------------------- By:------ 1 = ie�(D. nay Contractorl (Plot plan, showing size of lot, location 0 system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- l.._ ------- ---------------------------------------------------------- -- DATE ------------------------------------------------------------ REVIEWED'BY--------------------------------------------- -----------------------------------=- ------------------------------------------- DATE------------------- _ - BUILDING PERMIT ISSUED------------------------------------------------------------- ---------------------------------- ---- DATE ------------------------------------- Alterations and/or recommendations:--__ ---------- .--- -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•- ......---------------•---------•--------------- 4 ------------ -------------_________________________>____-_---- .. _.. _.//. /___...__--- - ------ --- _ _-__ ._ ___ _ >----_-__--._____-___-----_.__----___._--__-_-_-----__---..-----__-----__-.-_._.__-_-__---_--___--_---_---_.-__- -------------------------------------------------/�1.--_.._......_ .. .... __- - _I '.._... _.___._____-________._._..__._._....._____•_.•__._•_____._________._____._____________•-_.------------------ FINAL INSPEC �r�---------=-- ---- / Date------- 0(-_-__ J - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, Colifornto Lodi, California / Manteca, California Tracy, California i - - EB-9 REvi6Eo a -se r.P.co. 1M 6.60