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FOR OFFICE USE- ---------- �_._J�__-+�I APPLICATION FOR SANITATION PERMIT Permit No. `-- / P7. (Complete in Duplicate) ----------------- °-----______.___ "This Permit Expires 1 Year From Date Issued 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 w" h un Ord' nce No 54 , L soil � J48 ADDRESS ANDEL jOC TION = p �.-- ---------------------- Owner's Name-�� . ----------- --•-- -- ----- ---- ._. Phone-.--' ------------------------------- Addres :: .rf Address.-•----------------._...---------------------------••---•---••-•-----•-------• ` 7. Installation will serve: Residence�� art ��--.-__-Commercial�k _�.� -------------•_--.------•---•---- Phone .-_..__.....__�:'�............. Contractors Name_______________ _ _ E _ 6 j � p ❑ f ❑ railer Court ❑ Motel ❑ Other ❑ r q Number of living units: _/r___ Number of bedrooms -9-- Number of baths Lot size .._._---_-__----------------- Water Supply: }Public system' ❑ Community system ❑f Private Depth to Water Table 1f.,�_rff, Character of soil to a depth of 3 feet: , Sand ❑ Gravel ,E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ F ;. r , Previous Application Made: (If yes,'date-------------- _'`a=} No I�New Construction: Yes PNo E]1=HA/VA. Yes ®/'No E_], r TYPE OF INSTALLATION AND SPECIFICATIONS: i (No 11septic tank or, cesspool permitted if 'public sewerisavailable within 200 feet.)' ~ ' { k' T Septic Tank: + t Distances'from nearest�well___�g w_ :- Distance from fpundation --- �� CNb. of'compartmenfs- > --------------Size X��i�_Cquid`depth---��------------:_.Capacity-/A ®- ----- Disposal Field: Distance. -from neare f well -_!JY____._._ -Distance from foundation --- LI%___ ---._.Distance to nearest ot-line_t'�_...._______ .a,, �.r Number of lines:____ ____ Len fh of'each line___ w 5 ---`r Width of trench-- Type of filter material/r-! Depth of filter material --- length___-.,la____.-_ar®��7 Seepage Pit:" -'Distancerfo nearest ell____�ze___-__Distance fr rn foundation___._. ��j %(� . ..D��s nyre to nearest lot line:________ r�,� 'Numberr of its- -_'--__---. -Linin material-- ----- �.?__._------- Depth'1----------- I!4 p' g Distance Diameter___ Cesspool: Distance from -nearest well ----------------- Distance from foundation ----------- .------- .Lining material ----------- .__.______________._-_-- ❑ Size: Diameter- --- -------------------- Depth -i7 •------------------------ Liquid Capacity ---------------------------- gals. Q Privy:r Distance from nearest well --------------------------------------------------- Distance from nearest building --------------- ._____________-____-_--_. ❑Y Distance to nearest lot line ----------------------------- ------------ x ----------- ------------------------ ----------------••------------------- Remodeling and/or repairing (describe): ----------- '1 --- --•-------•-----------------•-------------------•---------------------------------------•------------------------------•--------•----- ----- ---•---------------------------- i ! ----------------=-------------•-------;-----------------•-------------------------------------------------------------------- . •------ ---- --•'------------------------- -----------------•--•- = ------------------------------------------•------------------------- ----- ----- I 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. (Si gned )------- -- ---------- --------------------------------------------- ner an ontractor) BY: ------_------------- •---••----•-------•------------------------------=----------------------(rtle) - - - - - ----------------- (lot plan, showing size of lot, location of syst ' ..relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTME T USE ONLY APPLICATION ACCEPTED BY---- -- 5 --------------- ------------------------------------------------------------------- DATE ------------ 7 - - - 47 - REVIEWEDBY ------------------------- ------------- --- ----- ------------------------------------------- •------------•------------ DATE BUILDING PERMIT ISSUED ------------ ----------------- - -- -- v_-- DA- E.---- - - ------------- ---------------- -- Alte ations and/ reco men #ipns:--1-J---�-��--.I---------------- ----- --- • �tl�-�� ► ��rz�_ Q�-y�:---;------•-- -------------- ........... - e__ � ------ ------------------------------ -----_---_- --------- -----------------_ -------------------------------- * ---------------- FINAL INSPECTION 'BY:.- -� �C Date._.-------�. = -------------------------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodl, Calif la Nanteca ,California }` Tracy, California L9.9 FEVIBEO B•59 F.P.CC. SM 6.60