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FOR OFFICE qE _ -- ----- - APPLICATION FOR SANITATION PERMIT Permit No. --- ------ - ------ K- - (_ �-L_1U_ _ (Complete in Duplicate) / ___ ______-________ This Permit Expires 1 Year F:,Yom Date Issued Date Issued Application is hereby made to the San Joa uin Local Hea14h District for a permit to construct-and install the work herein described.' This application is made in compliancy Co my Ordinance No. 549. .b $ JOB ADDRESS AN ATION_ y�-- �.c �------ ---------+-•--------:- J�=Q •---------, one.:- ` Owner's Name. ----------------- Address.-...1--------------•--•---------------------------•-•` ------------ -.:.----------- `� � ------ --------------- r •---...- ------ ----- ------- Contractor s Name--------------------==--------------------- ------- _C�s^r�'- --- ---- -�----r� �� :. Phone _ � �� ` Installation will serve: Residence ❑ Apartmen House .❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number Of living units: ______-. Number of bedrooms _:_ :___ Number of baths ........ Lot size -----------------------_____________________________________ Water Supply: Public system .J4 Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [-] Sandy Loam E] Clay Loam ❑ Clay 1-1 Adobe ❑ Hardpan E] P. Previous Application Made: (If yes,date--------------------) No 54 New Construction: Yes ❑ No FHA/VA: Yes ❑ No f 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_'/)V.�-Distance from foundation---142 ..Ma eri I No. of compartments-------- -_ �� -----4-Z..Liquid depth__-. __. _. .__ p y - Size-,5 Ca acit �Oc Disposal Field: Distance from nearest well _ -CA-abistance from foundation __0__________Distance to nearest lotff a Number of lines----- ��-__�Z)-_.______Length of each line__^__ ff Width of trench_ line __ ____.-_._.__ Type of filter material__kOG - Depth lof filter material.__I_---___r______Total length_______ ___.!___Seepage Pit: Distance to nearest well_AIOA)�___Distance rom oundation_�-(._____.-.Distance to nearest lot _ _______:__. a Number of pits.__. ___S�`CL-� �_Linin material___ Size: Diameter`__ g .-3 -------- .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----------------------_-...•_...____--_._. Q ❑ Distance to nearest lot'line-- --------------------------- ------------------ -- ----- ----------•------------ •-••------ _ _ r i1 , Remodelin 9 and/or repairing (describe):--------- !' ''L -- ------ to � �� ------------- I hereby certify that I ha pr pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and es nd regulation of t San Joaquin Local Health District. r_ Owner and/or Contractor) (Signed)---------------------- 3 By: ............... ........Gf!% il{� 1/� - (Tltle� 4 2 _.(1: (Plot plan, showing size of lot, location of system in relation to wells, buildings,'etc., can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ----------------------------------------------------------------- DATE----- q ' - ---------•---•------:-------- REVIEWEDBY--------------------------------------------- ----------`-•-•--------•------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------••---------------------------------------------------- =-------------------- -- DATE----...-------------..--------------------------------------- s Alterations and/or recommendations:-_- -J------------ '---a.+n.S�E_ "(-�C� 1----"--•---- -it------ -------lS....... ---�--��e ---------•---------------------------- •-----------------------•--------------------------------------------------------------:---•-----------------------------•----------------..--------------------------------------- --------------------------------------------- -------- - ------------------- ---------------------------------------------------------------------------------...-----.--••-•--•---------------•---•-•------•----------------•---------------------.... - ------------------- •-------------------------------------------------------------------------------------------------------------------------------------------------• -----------------------------.---.-------- FINALINSPECTION BY------� ------- ---------•------------------ Date------ ---- ' ------------------I------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street a Stockton,California Lodi,California Manteca,California Tracy,California b A Ef7.9 F[V16E0 B•59 F.p.CO.2M 6.60