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FOR OFFICE U E: - ----- -- -- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ z4 3 -------- ----------- ----- --- - --- (Complete in Duplicate) i _______ 'This Permit Expires 1 Year 1From-Date Issued Date Issued ....�.z.,7�/ Application is hereby made to the San Joaquin Local Health District fore permit to construct and install the work herein described. This application is made:in compliance with County Ordinan a No. 549.; F JOB ADDRESS AND LOCATION--------�v{ ---{�---- - ---------- - - ----- - - -----�f --------------- ---------------------------------------_ Owner's.Name--------__ _* ---_F-- � , t . ' Address.. '�1. ---=------------------- ------------------- ---------------=•--••----- .................. Contractor's Name------------------= -t�c.�'��2'- r.. ------------- Phone------•--------------------------•- Installation,will serve: Residence .Apartment House ❑' Commercial ❑ Trailer' Co rt ❑ Motel,[:] Other ❑ Y Number of living units: __1'____ Number of bedrooms -__ Number of baths - __,Lot.sile -_".__X-_/10-___ _____________________ Water Supply: ;Public>system,A Community;system ❑ Private ❑ Depth to�Zte Table 36 ft. Character of soil-"+o a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cley Loam ❑ -Clay ❑ "A&6 W' Hardpan ❑ Previous Application Made: (if yes date.'-_____ __::__ } No " New Construction: Yes ❑ No FHA/VA:,Yes El No Ik TYPE OF INSTALLATION,AND SPECIFICATIONS:,!�., (No septic,tank or,cesspool permitted if public,sewer.is available within 200 feet.)'-r., Septic Tank: Distance',fromnnearest"wail___ ------- from foundation________.____..__.Material_._________:____. a No. of.compartments-----------------------k--S,ize,-----••---- !---------Liquid depth-------------------------Capacity- ------------------- Disposal Field: � f Distance from nearest well..._Distance from foundation.--A0____..___-Distance to nearest lot line___________ 20 . Number ofF as___:__?____ ________________Length of each line___., �.Width of trench..___ ,? _.`�______.______--- {, 1 Type of"filter material Depth of filter material___:./. __ Total length___=___1.6___________________________ Seepage Pit: ; Distance to nearest well:_- -----:.Pistance from foundation'.. t nearest lot li e_____-- --_/..- Number of pits ________'__Linirsg materia` __._ ize: Dia�nee '-�'�j _pDepth.....e -----------------•... Qj Cesspoo Distance from nearest well_________s 'Distance from foun ation_.________'_ _.Lining material____________________________________ ❑ ' � Size: Diameter- -----e--r-- -- - -,� Depth ---- --- -- ------ -- -- ---7�7t-'Liquitl Capacity....•-----------------------gals. - t Priv Distance from nearest well_________----------------------------------- ______ _ `�� Distance.from.-nearest..buildin -- --------------------------------------- Dista' n'ce ---- -- - ❑ � .� Distance to nearest lot line---' Remodeling rid/or repairing,,(describe):_ ___-- __-- I Ap 3. ' { # ---�-- ----L------: ,, 3, 1-t) �1� .L - - ------- I hereby certify that I have prepared this application and that the work'will lie-done in accordance with San'Joaquin County' . ordinances, State laws, and rules and=regulations o4ADanjoa�cal Health District. L (Signed) --------- ---- ----= =--------- = `-------------- ------(Owner and/or Contractor) `x BY:------------------------------=--------------- - = ---=- (Title)-------------------------------- --- --- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ` L t FOR DEPARTMENT USE ONLY i ` - ------- DATE------ -- APPLICATION ACCEPTED BY,___-_- _ �_ :_ _ ------- -- - REVIEWED BY------- = DATE ----•------------- ----- - ------------------------------- BUILDING PERMIT ISSUED = - - ---------------------- DATE Alterations and/or recommendations:__ 1 - ' :-- - =----•----- -:------ -----------------------------------------------------------" �� ------------------------ --------- -----•----- -----------. --- ----------- ------------- ----------------- -------------------------- - � = T ------- --- •-- ---------- --- --- --- = --------------------- ---- - --r----------- -Z -------------- - -- 71 FINAL INSPECTION BY:. -r C-- , _ ' Date- �" / ----------------------------------- S—S ' -.SAN JOAQUIN'LOCA0 HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 V41i 01h Street I Stockton,California Lodi,California Manteca,California Tracy,California E9-9 NEVIBE6 H-59 P.P.CD,aM 6.60 _ J