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FO OFFIC,E 1�5E: � . ---------------- -----------------.--------------- APPLICATION FOR ,SANITATION PERMIT Permit No. - / { ---------------------• ------------ - ---------- - (Complete m Duplicate) Date Issued ....... ... ------------------ This Permit Expires 1 Year From 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. J09 ADDRESS AND LOCATION...!_/_Xi_-ll�------ Owner's Name------ _. x' Nom' -----------c----------•---------------- ` --------------- - -•------------------------- --------- Phone.-�l.-"_�°.,�_� Address -------------------------------------------------•-•---------------------------.....-----•--••---------------------•--• Contractor's Name.. -��_OAKS ./W-M-.--.--- Phone_1.7" 6 7 Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._ __ Number of bedrooms ._-*- Number of baths/ Lot size ---7J.'0_X.....11V.`......................... Water Supply: Public system [Community system ❑ Private ❑ Depth To Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date---------------- ---) No R-'*�'New Construction: Yes ❑ No ka- 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____---_--._-----.Materia!___._____.___.._._.___........_____....______... Ele1 No. of compartm.ants--------------------------Size--------------------------------Liquid depth-------------------------Capacity--------------------_- I Disposal Fie d: Distance from nearest well.Nelle Distance from foundation...A ----- _:._._. .... to nearest lot line._ Number of lines ' ,- ..------_-�------ ----- ----Length of each line-•-.---- -------------Width of trench.-------_2%? _JL.. ________--. rf 3. fType of filter ma.terial__/R'C*X----___.Depth of filter material...../ -----Total length --5- ------__--___-.- Seepage Pit: Distance to nearest well-----------------------_Distance from foundation______________ ____Distance to nearest lot line.______________._ ❑ Number of pits---I------------------Lining material-----------------------Size: Diameter------------------------Depth------------._-______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material--------------------.__-----•----•__ ❑ Size: Diameter--- I---------------------------------Depth-----------------------•----------r----------- Liquid Capacity--------------- ----------gals. " Privy: Distance,from,nef arest.well-------------------------------------------------Distance from nearest building--------------_-___-_----- i ❑ Distance to nearest lot line . F Remodeling and/or repairing (describe):---------...09491�--------Ax /l/w i _..."' = t I --------------•------------------------------------------------------------•--- ..- _- -•-•--------------------•----------•------------------------•------•-•--------••-----•------•---••------------------••---------------- ---------------------------------------------------------------{-----•-----------•--------------------------......--------------------------------I---T--- ---------------•---•-----------•------------------------------ --------------------------------------•-----------------• ------•----------------_--•--------.. -------------•---------------------•------•-------------------•-----•-------------------------------------f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' , e (Signed)-----•-------- �'� --•- .. ---------------------------------------( wner and/or Contractor) sr• ------------------------------------- ---------- {r+lel= _ (Plat plan, showing size�offllot,,locat- -io. of,system in relation,to wells, buildings, etc., can be placed on reverse side). -- -- j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY/-.L/--- ------------------------------------------------------------ DATE-- A- f REVIEWED BY------------------------------------------ --- •-••---------------.._ DATE BUILDINGPERMIT ISSUED•-•--•----------`-----------------------------------------------------------•------------------._-.-- DATE Alterations and/or recommendations: .-------------------•------------- -- -------------------------------------------.j.... I t -------------------------- --------------------' FINAL INSPECTION BY:----- Date0"& �1 +—:--------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreel 124 Sycamore Street . 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59'2M 5.65