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FOR OFFICE -USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.-...j..� (Complete in Duplicate) Date Issued -----`-- ; /+r -••--••a ------------------------- _--------------------------- ---- 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. S49. JOB ADDRESS AND LOCATION--------------2L1-":5n-'¢----------•-•------------------------------------------------------------------------ --_--------------------- Owner's Name I �1�� / S _E% �--------------------------- ----------------------------- Phone._ ��. � S_S" r� • . Address---------------------------------------=-----------------•-•-------------- Contractor's Name ------ •--•------------� Phone Installation will serve: Residence C Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ :Number of living units: ____L Number of bedrooms A2-__ Number of baths ________ Lot -Rsize------- -------------------------- Water`____f_____________________ Water SuPP Y Public sYstem�CommuriitY system' � Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 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.) dr Septic Tank: Distance from nearest-well__�/*f Distance from foundation --- sa ________ Material _PIC/__ _ _ . No. of compartments_._____ ---rte Size____�1__' X__�_i--_�__Liquid dei?th...._______.l_______Capacity___S"4 _______ Di sial Fi & Distance from nearest well_-.%� !�Distance from foundation_...-_._ Distance to nearest lot I fe_________________ j--------- of each line____________ __ ______ __ Width of trench_______ ` Type of filter material_b�.____.___Depth of filter material --_--_l_ _a�____Total length ------------ eepage Pit: Distance to nearest well_ V/V/ :___Distance from foundation -------------------- Distance to nearest lot line ----------------- Number of pits-------- ------Lining material ----------------------- Size: Diameter------ ------------------ Depth ------- •---------,--••-_-----..._ Cess go[: Distance from nearest well ----------------- from foundation ----------------- --Lining material ------------------- .-________________. Size: Diameter-------------------------------------- Depth -----•-----------------•------------- --- ------ Liquid Capacity ----,- --------------------..gas. Privy: Distance from nearest well -_._________________________-.____.________.._._Distance from nearest building ---------- .__-_____________._._ ._._ ❑ _. - �..�. — -- = ' -------•-•-------------------- Distance to nearest lot{ine----=�'-----------------=°---------------------•---------------------------•---=---------------- --• - ------f Remode%l�'n anor e ring , e nb }:. �� ----44 jJ f --------- d/ ...... .; ----------u� _______________. 4 -------- -------- --_________________________________________________________S______-________________________-____________-___--_________-_.--____-,_-____________---_____..._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and re ulaiions of +he San Joaquin Local Health, District. t (Signed) -•'t` ----fir � -----------------------------------------------------------------(Owner and/or Contractor] BY:----------------------------------------- ....... ------------------------------------------------------------------------------ --(Ti+le)------------------------------------------- ------------------ (Plot plan, showing size of lot, location of system in relation,to wells, buildings, etc., can be placed on reverse side). I 'FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY------- __-'. ----- DATE------� ------------------------ - - ---- - - ----- ---- --- -- -- ------------------------------------- REVIEWEDBY ---------------------------------- ---------------------------------------------------- --- DATE----------------------- ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- •----------------•---- DATE--------------------•-----• --------------------------------- Alterations and/or recommendations----------------------------------- --------- ----------- .::.-•----------------------------------------------------- ---------------- --------------- ._------- -----------------------------------.-•------------------------------ ----.----------------------- -------------------------------- •---------------------------------------------------- ------------------------- -- s -------------------------------------------------------------------------------•-----------------------------------, ---------•------------------------------------------- -- - --------=----------------------------------------------------------------------------------------------------------J----. ------- . Date --TION BY:. G- i FINAL INSPESAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California EB -9 AEVI9E0 B-59 E.P.CC. ZM 6.60