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FOR OFFICE USE: D 0 S—('90—&r( .. -- •.. .....-.... APPLICATION FOR SANITATION PERMIT Permit No. �s .....................-...._.-- ---------------- (Complete in Duplicate) 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 consKt E k herein described. This application is made in compliance with County Ordinance No. 549. IJP•/ 1J JOB ADDRESS'A1It4D LOCATION. Owner's Nama.yj. - /3�wKeu............................ Phone one.. Address..............---.l �:.. Contractors Name.-.--.-.-- .. Phone....'-....—..................... Installation will serve: Residence ❑ Apartment }-Souse ❑ Commercial ❑ -Trailer Court ❑ Motel ❑ Other a Number of living units; ........ Number of bedrooms ....._.-. Number of baths ....__ Lot size .......................................................... Water Supply: Public system ❑ Community system ❑ Private [!erDepth to Water Table 19 ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ /Clay Loam❑ Clay rU' Adabe❑ 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 sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation..............------Material............................................... ❑ No. of compartments..........................Size ----..-----------..,--Liquid depth.....----......---------Capacity..._............ Dis osaJ.field: Distance from nearest well.... Distance from foundation.....1.fL.......Distance to nearest lot line..._:......... ® Number of lines....... ......:......:......Length of each line...... ....Width of french.....:j=_........-------------- Type of filter material..X.A?�........-Depth of filter material...... ......Total length......... A!.t_............... See pe a Pit: Distance to nearest well......lO u!-•,_Distance from foundation..._._I�....r..Distance to nearest lot line..!E._...- fv Number of pits.................Lining material....S .._.......Size: Diameter-.......r1t!'..-..Depth....,r2.S.................• 10 •Cesspool: Distance from nearest well........-.._....Distance from foundation....................Lining material................-------_..-... a-I.. ,g, El -- - - ...................._Size: Diameter....-- - ......--- --..........._Depth. - .................._.....Liquid Capacity.......-....................gs.. Privy: Distance from nearest well...............................................Distance from nearest building........ ❑ Distance to nearest lot line-------_........................ ....................____........____.........._............__.......�. Remodeling and/or repairing (describe):---...... ....----..................-..-----....------_.---...._.....----------..-•----......-.............-•---..._----•----.......may 7L ................. . - ......... .......___..........I•- ......• ................ - .. .................._. ................_.._._..---- •• --........... ..............--_ .........- ............., s . ... .. ............I ....-......-----_..------.............-......--------•-----......------------- .•....................-------- .. - .----- --- ---- 0' 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin oun ordinances, State laws, and rules and regulations of the Son Joaquin Local Health District. ( 'St ned -------- ._` " .. r�L�F u !.._.-.....-----------------..._--------------•c-(Elrimn rid/or Contractor) g k.....--..... By:....-----_.�r ....... :...... _... •.-•• --.........-••---... ---..{T ...................... —..... ...... -... (Plot plan, showing size of lot, location of system in relation to welts, buildings,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... --...-__ ................................ DATE..LO... ...... ------------ ...... REVIEWEDBY..................._.._...............__...... ............-.................----...........---- DATE...........--....----------. -----.--------------... BUILDINGPERMIT ISSUED----------.----...--------------------.............._.----....- ........----............ DATE..........._............................................ Alterationsand/or recommendations:..._.......................-----------..-_...................................................._.........-........__................................. ...................................................................................................................--............................-....... _.......................................................... ...............-.................- ....._..........................------...........---................................._................................_............................................ ...................._...... . ...................._.......------------.......----------....------....-•---•---...--........................................................................ ..... ..........................................................._.....................................................................--................................................................................. FINAL INSPECTION BY:.. _....C... Date. ..........7..:Za-'.6.4............. • SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacelfan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cal90mfa Lodi,California Mame<o,California Tracy,California Ea 9 RCVISEO ®-59 O,a ] '63 f.P.CC.