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FOR OFFI E US�:' _ f 7��` -------;9- -------- ---------------------- ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ---------------------------- (Complete in Duplicate) --- ,This Permit Expires 1 Year From Date Issued Date Issged -____1/ o_/._l Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- --------- 5 71 Ct.__- � Y[ .ort�1!_ .?s_' -- �"."' 15-o Owners Name---•--------------•-------- LG.. Phoned 3 •SSq- Address Ira _,6744--;!_7d/------------------- t Contractor's Name..---••-------------••------tea...�� s�� t�CT�,.r�__... - �__� `�_c. Phone-•---•--•--- , Installation will serve: Residence 1�, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---'----Number of bedrooms _<?_- Number of baths __f---- Lot size ......... l------------------ Water Supply: Public system 30 Community system ❑ Private ❑ Depth to Water Table-.!Y47-ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ F Previous Application Made: (If yes,date-----------------.___) No g New Construction: Yes No ❑ FHA/VA: Yes1K Noj TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_& __Distance from foundation-----�d._______.Mater',al___- _f4' _ . - No. of compartments____-- - _____.__.__Size__--1_-_--- _ _ Liquid depth__________ _ _____._Capacity_.. b Disposal Field: Distance from nearest well.116%1,o_.Distance from foundation.....141---------Dista.nce to nearest--164 line.....z&--_,-.- Number-.Of lines___.------ ( '--------Length of each,line a_L'j l -.-� Width of trench______________a��_____--_--_;- Y Type of,.filtermaterial_ th.of filter' _____/_ Total length Seepage Pit: Distance to nearest'well___yff ___Distance from foundation___--/'_- _-_-_-.Distance to nearest lot line_ z_,'_---_ Number of pits-------2--_---_-___Lining material:=? :,_-Size: Diameter----__ Depth-------o2S__/---------------- Cesspool: Distance from nearest well from foundation_..____-.___-_----..Lining material_-_.-----_.-----_____._.-__-_-------. r.. " f Size: Diameter------------------ 0 ---------=----- -Depth------------------------------------- 1==------Liquid Capacity----- ;---------------- gals. ,' Distance.fr ftp nearest well-__-__.------------------------------------------Distance rom nearest building Privy: Cf ,. 9 j-----.--•-- ❑ ;` Distance to nearest lot line-- ----------------------------------------------•------------'---.---.---------------------------•--------------- -----------------•-------- Remodeling and/dr repairing(describe)------------------------------------ - ' } x--------------------- •--•--------------•----- ......................... --------------------------------------------- ' ' -------------------• ! ' 11 ---------------------------------------•--••------------• -------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Actaquin County ordinance s,.Stat laws, an rul d regula ons San Joaquin Local Health District. . , I (Signed} -°=' = ------------------ -------------------------------------------------------=-----------(Owner and/or Contractor) By:--------------------------------------------------------•- °-•----------------------------------------------------------------------(Title),•..--------------•----------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------------=----------------------------- RATE--------- -----`----------- --- REVIEWEDBY----------------------- ------------------------ -------------------------------------------------------------------------•---- DATE ----- -------•--•---------------- ' BUILDING PERMIT'ISSUED-------- DATE --- ---------------- AI#era#ions and/or recommendations: =-----------------------='-----_--- -----�'�"__=" ----- - - 7 ---- ------- --------------- -- -- ---� ----- -------------------------- 10� - -------- --------- FINAL INSPECTION BY: �r- .-6.1--------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,CaIlFornia Manteca,California Tracy,California ES-9 REVISED 8.69 F.PX0.2M 6-60