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FOR OFFICE USE: ; -- -------------------------- IM APPLICATION FOR SANITATION PERMIT Permit No. --------------•-- -------------- ----------------------(�- -. (Complete in Duplicate) Date Issued ..� --�'•-• �3 _ IMI j This Permit Expires 1 Year From Date Issued Application is hereby b to y made I� A the San Joaquin total Health District for a permit to construct and install the work herein described.This application is made In compliance with County Ordinance No. 549. I IN: JOB ADDRESS AND LOCATION----_a-9.Q.-�-----•.-�_�._1nn.�l---• .� __.._..... Owner's Name------- �I t ` -----•------------•----------•-------- ------------- Phone------------------------------------ Address ----------------------`------------ Address..--------�-cl QA•----•--... ------�- �.-_---------------- ------------I_---------------------------------`-----------------` -------_- .......................... Contractor's Name-----.C3.1 h1�.11.E_Y.....-----•------------------------ Phone..........---------"_.-.----------- Installation will serve: Residence E& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ."" "__- Number of bedrooms . .. Number of baths ---I... Lot'size ------(....poc'C�.......------------------------- 11 Supply: Public system ❑ Community system ❑ Private ES Depth To Water Table ��- ft. Character of soil to a depth ��f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (:If yes,dote__' -) No tk New Construction: Yes No ❑ FHA/VA: Yes ❑ No U �I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)1 I Septic Tank: Distance from neares+ well S4�___-_Distance from foundation :_i..Q___-____.Materia�__'Cd_l.5?Q_4. ................... No. of compartments--------Z----------Size_: _ -,—�.'-— ----Liquid depth-_-4� ---- Capacity... ------ No. t Disposal Field: Distance: rom nearest well--�_i�_____Distance from foundation..S f_�?__:..`.Distance to nearest lot line__ _____---. ber of lines___..-'..-"7�'+__----__.-___Length of each line..]-44__.---..-Sd-.Width of trench..__:�_4:.._______"-_._______ Num a � Type of filter materiaLS.�,__t'6�._ .Depth of filter material.____}__ ..__._.-Total length______I_ Seepage Pit: Distance��to nearest well_____-J__0_GDistance from foundation..._j_-Q.°_...__.Distance to nearest lot I � t t Number of pits"____Z`._---___"--Lining materia ,___i > + -Size: Diameter__41X�.�a_______Depth____.�._______"-------------- I�. Cesspool: Distance .from nearest well----------------_Distance from foundation--------------------Lining material_____.......__-__._.________.._•._._ ❑ �' ________-_Li uid Capacity ala. Size: Diameter. Depth q P ty---------------------- 9 I __________._Distance from nearest building' Privy: Distance from nearest well-----------------------•---•----- - g -------------------•-••----------•"--- ❑ Distance to nearest lot,line- ---"-----------------------------------------------------"-----------------------------------.--.-------•---------------------------- Remodeling and/or repairing (describe) ------------------------------------------•-----•--------------------------••--------•-------------------------------------------- i ' I --------•---------•-------•----"-------------•------------------------------------•------------------ k ------•------•----•-•----------'•--------------•------------------_--•--_----------------•-•--------------------------------- ----'•--• I hereby certify that I Piave prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and` ules and regulations of the San Joaquin Local Health District. ------------------------------------------(Owner and/or Contractor] (Signed)._.--i J - {c-- -- (/ By:-------- ------I "-•- ---------------------- -----------------------------------(Title) (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY----C-- -5 -----•----------- DATE..__ z_`_`ZS_�_S�x --------- ---------------- l REVIEWED BY-------- I -------------------------------------------- DATE BUILDING PERMIT ISSUEDM------------------------------ _ DATE 4 -- ---- , Alterations and/or recommendations: f + ' � -- t Y) ' M .. - -------------- ------------------- -----�I-------------}----------------------------`----- -- -- ---------- Qw 5 ^ :--------� -----�'--} � -- ------,Q t..,_.. -. FINAL INSPECTION BY:;--- ---�----• - - --�----------------------------- Date----- 9--- �� r SAN JOAQUIN�LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California Es 9 REVISED a-59 EM 0-52 ATLAS