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FOR OFFICE USE: -------------------=------------------------------------ t APPLICATION FOR SANITATION PERMIT Permit No. ...l._ :_......l... t D i l C --------------------------------------------------------- (Complete n Duplicate) /!I _.., _ Date Issued ____-../._ ------------------------------_--_.-------------------- 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. 549. JOB ADDRESS A,Np LOCATION_..---- �'6` � - �Q7_�a _ -+--------- � K t p ---------------------------- Owner's Name---- - -------------- r L ••__-•- .....--•-------------------------------------------------------------- Phone. _' -ya/ Address--......:75A.Aol ....-... _-:.... •••. . -------------------------------------------------------- Contractor's Nam ehlN ... :^ ^--------------°"' Ib•-•-------- - Phone ..... ..................... Installation will serve: Residence Apartment House E] Commme c a ❑ Ira ler Court ❑ Mot, ❑ Other ❑ Number of living units- .1----- Number of bedrooms __ Number of ths --_._-_ Lot size _-_-..-E- f _---_-................•.-_--___------. -_-----_--_ ftO me Water Supply: Public system ❑ (tommunity system ❑ Private Depth to Wa#er Table t: Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Jarri ❑ Clay Loam ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank-or cesspool permitted if.public sewer is available within 200 feet. Septic T : Distance from nearest.well-_jO a-_-.Distance,frorn l' dation----I --------Maters I--- _ __.--- S �. t^s�? No. of compartments---a_ ...-- -----Size-Iz-: -y--x--- • ---Liquid depth----- - -- __--.Capacity-.�------- ------ r ' Dis osal 1d: Distance from neares well__&W__._Distance froth .foundation....................Distance to nearest lof line- - --- fs ---------_-- 't- --------- � 3Width of french------- __ __________________Number of lines------- -�--_.__-_Length of each!line----- - _--._--- ------ Type of filter mater•al----Rfl-ys Depth of fltt terial---- ------Total length.----/ / Seepage Pit: Distance to nearest'well_-_-----------------Distance fromfoundation-----------------..Distance to nearest lot Ime._...-._---____-_ ❑ Number of pits----------------------Lining material----------_-_---------Size: Diameter--------------------lk-.Depth-------------.---_-.--_---------- Cesspool: Distance from nearest well-----------------Distance from:.foundation---------------------Lining materal_--.----.-.-------_-_-------- _:.__-. ❑ Size: Diameter------------------------- ------Depth------------- ------------------------r------------Liquid Capacity-----------------------__gals. ----._Distance from nearest building ----.--- Privy::' Distance from nearest well___________________________ ----_-_-�- g---�-------------------------- - , ❑ - _ - ---------------------- Distance to neares} lot line-7 - I - i . Remodeling and/or repairing (describe):------- ----------------------' ----------------------------------------------------------------•------------------------•----------- l a ___----_-____-•; -_i:,___-_.---_----._--_-------_-------_----_--._.- ----------i------._-------.---.--_.--------._..--_----___-__-_-----_-_-_--_---____----____-----._-_------_- _---_i-•__-_-----_-__- --------------------------------------------- ------------ -------------------' ' - :------_-_----------------...-..---.-..----_---•---------------------------- __ ! hereby certify tht I have this application and that the wokwill• ie`done�in-,accordance with San Joaquin Coun+y i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 15R 51 ned {Owner and/or Contractor) U BY: =---------------------------k-------------------------------'------ (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY-.- t_ - --- - ----------------------------------------------------------- DATE----f �--- REVIEWEDBY-----------------------------------------`---------------------------------------------- - •---------------------------- DATE.------..-..-----------••-------------- -------- BUILDINGPERMIT ISSUED-------------------------------•----------------------.-------- -------------------------------------- DA-TE.------------------------------------------------------------ Alterations and/or recommendations:--------------T-----------------------------------------------------------------.. --------------------------------------- -------------------- ------ ---------------------------------------•----------•--------------•----------------•-----------.....------------•-•----------------•--•-•-•---•-------- ------------------•----------------------------------------------- ------------- --- ------- --- --- -------------------•--------------•--------------------------------•----------------------------------•------------- ----------------------------------------------------- ---- - -=------------------ - ----- - - ------ ------------------------------------------------------------------------------------•---------•---•---------- I --- -------------------- ----------- ----------------------------------------- FINAL WSPEC Date � - - v---------------------------------------- SAN 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 E9-9 NEVIBEC 2-39 F.P.CO.$M a-a0