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E.FOR OFFICE USE: r { ;• p d ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ----- - .71 I ---------------------------------------- (Complete Duplicate) �/ P This Permit Expires 1 Year uFrom Date Issued Date Issued ------w__-----•%f 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. JOB ADDRESS A LOCATION_: _ -Gc - ----- Owner's -Owner's Name--- •------- -- ----- --- �.4-- Addres5----•�1 J-•••--- .. --_ .�-,, ------ ---- --- -- -- - � Phone.:/ ---';- Contractor's Contractor's Name Q '�ct. .. _ _ .._ Phone�.... _23_a-3 Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms ________ Number of baths ........ Lot size ______________________________________________________.____ Water Supply: Public'system,Y❑ Community system ❑ Private [:] Depth to Water Table _1_t- ft. fi , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam t4 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 pwer is available within 200 feet.) Septic Tank: Distance from nearest well _____Distance from foundation_ID_-`-:a-......Material--- R -------------------- No. of compartments_________ . e.. X -X_ _._. Liquid depth Capacity.-1606- 0 Disposal Field: Distance from nearesf wellisfa�ce from foundation-.,S_--__ .......Distance to nearest lot line______.' Number of lines'_____------- +�_---_---Length of each line_______ r 9 --- ---N!idth of trench.--- - ---•--- Type of filter maferial__�0L' Depth of filter maferial_______l_ _____-____Total length-_-_-_ ,�_©_______-- Seepage Pit: Distance to nearest well______________________Distance from foundation----------------------Distance to nearest lot line------- _.__.____ ❑ Number of pits-F__-_----- -..___--Lining material_______________________Size: Diameter__________-___.._ ------.Depth-- -----------------�''-----..-. Cesspool: Distance from nearest well--------------_'Distance from foundation_----- --------------Lining material------------------------- _-______- ❑ � - Size: Diameter__-- __ � Depth--- -------y-------�---------r--f---Liquid Capacity-.-------••--------` :'.gals. -- �.: � ._.:1 _.. Privy: Distance from nearest well--------------------------------------------------Distance from nearesf b 1-�;" -------- Cl `iline - - Distance to nea est lot _______________F_-_____-._ -------------------------------------------------i Remodeling and/or repairing (describe)-------------------------------------------,------------------------------- ----------------•-- ------------------ ----•------•-•-------- -------- ----------- ---•-------------------- i --------------•-----------------------------------------=-------- ----------------------------------------------- -- k i! ------- ------ I---- •------ -----------------------•-- ----------------------••--------------------------- - --------- N` l -- ---------------------------------- - - --------- - ! 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 �f ,.(Signed);:_ -.----�- - -- - -_ � - ,r_`-��"'.,r -�- -, �� - ------ ,-- --- {OwnerYand/_or Can_tractar�_ ... 17 ---- -- -- --------------------------------------- { ' Y. . Plot plan, showing size of lot, location of system in relation to wells buildings,,etc.;:can 6le1 placed on reverse side). _ { P 9 Y -s. _ , ` FOR DEPARTMENT USE ONLY r I!i APPLICATION ACCEPTED BYt _ ---- ---------------------- ----- •------ ------. DATE _ i,.. REVIEWED BY Je BUILDING PERMIT ISSUED ----- DATE Alterations and/or recommendations.----------- li .._ -----.------ T ---------------•------------ - --------------•-•---------- ---------•----------------------•-------------------------._ '. ------ ------•----------•-- lI ---------------- --------------------------------- ------ --- ----------------------------------------------------------= ----------------------------------------•----------------•--•---------------..-- --•--•- -------------------- --------------------------- ----------- ------ r ---- - ---•----- ------------------ - -------------- FINAL INSPECTION BY-------------- -'----• - Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT l• y ,I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVISE❑9.59 F.P.Ca.3M 6.60 k t.� I