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FOROFFICE USE: t ------------------- ---- !, -�'-T---- -.--�f� - 6-L_____________ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------ -- (Complete in Duplicate) //. / ---------- ---------------- ----------------- --- .:This Permit Expires 1 Year From Date Issued Date Issued •----1._?�:. __b/ I q(--1303� 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. 2 JOB ADDRESS AND LOCATION _ ------------------------------------------- Owner's 1AuTcaOwner's Name--- - _. J � TT y Phone .............. Address -4 2...--�_��-�L_f=_f.?.d2�.. �?� y �`I KZ...--- .......... :...... Contractor's Name------------ tr4_-fs�if.._--------IJosETiAI-_�- _, Phone = --•--•---.------ Installation will serve: Residence & Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � f - Number of living units: ___. ___ Number of bedrooms _2,, Number of baths ___1___ Lot size ___ -- '_: __- �c'..1___---__-__-•_-__-.--_ � Water Supply: Public system ElCommunity system E] Private 11 Depth to Water Table 40'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j Clay Loam L]"Clay , Adobe[V Hardpan C]Previous Application Made: (If yes date------�_____ _ ) Nod New Construction: Yes [] Nom FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: S i. (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) ?kl Septic ank: Distance from nearest well___14)------DistancetfromoundPtion__.__i ________.Material_ ________ --__flUCI(,Q N 19 No. of compartments......Z .-----•--- ----,Size-_---)(- -_X- -----Liquid depth.----4 ----------------Capaci Dispos Field: Distance from nearest well--- ------Distance from foundatio --- to nearest lot line...�a��___.___ ' Number of lines----- KQ 2 i r ��T- --- Length of each line------- --- --- Width of trench`--------•i--,--•---•--------_-••-- Type of filter material--- -- -----------Depth of filter material-----I-T------------Total: length--------(-6d..... ---__--•.__--__•i---_ �1 Seepage Pit: Distance to nearest well---------------------- from foundation------------------- Distance to nearest lot line.________._..____ ❑ Number of pits------- ------Lining material--------------------=-Size: Diameter----..----------------..Depth------------------------ ------ Cesspool: Distance from nearest well___--r --,_-Distance from foundation__________---_-----Lining materia------------------------------ Depth __.__-______-.._______._._- " - .. ❑ Size: Diameter Depth--------------------- _ -------Liquid Capacity----------------- ----------- Privy: ---------- I Privy: Distance from nearest well-----------I-------------------------------------Distance from nearest building----------------------------------.ga _---� ❑ Distance to nearest lot line----- ----------------------------- ------kit ------------------•---------------------------------------- Remodelin and/or retairin describe :______ _ _ [�/� ` 9 / p g ( 1 ��------�`�GII�_�-�------- .Shr_!_1!V'�.---••-�-l'-`-?-�----- --- L�k�---------------- - ------ ------------------------------------ ---•------------------------------------------------------------------------------------------------- ---- -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou nj- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ :- ------------ ,_11fir' ----------------- --------- ------------------------------ ��and/or ContractY= - (Title) Contractor) (Plot plan, showing size of lot, location of system to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -----------=---------- "- ;5� ----k ------------------------------ 1 DATE REVIEWED BY . ------------- DATE-- .- ~ ------------- ----------------- BUILDING PERMIT ISSUED------------------------------ ---- ----- ----------- DATE-------------------- Alterations and/or recommendations___----------------_------------ - ---------------------• -------------------•-•-------•----- ----------------------------------- -----------------------------1-11-1----- ---------------•-------------------•--- --------------------------------------------- •------- •- - -------------- ---- :-j ---•--- - ------------------•---- --- FINAL INSPECTION BY:------ Date . ; SAN JOAQUW LOCAL HEALTH DISTRICT 130'South American Street 300 West Oak Street f' 124 Sycamore Street 205 West 9th Street . Stockton,California Lodi,California Manteca,California Tracy,California E6-9 REWBED 8.59 F.P.=$M 6.6a