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FOR OF�I ..E USE: I��I --- --------------- -`--- � 6 il' Permit No. ,F." APPLICATION FOR SANITATION PERMIT - ---------------- ------------------ // 11---- (Complete in Duplicate) Date Issued • -�h This Permit Expires 1 Year from Date Issued Application is hereby madel�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. Y / �rJ JOB ADDRESS=AND LO -ATION.._. ------- -------- , . _t tri'_.– ��?.�. - Owner's Name-_.___ � .�� " •�•--- �-�--�-/��- �1- Phone------- ------------ Address.----•---�z=�'`- � -------- - ..,� ��tr�'---- ------------••----------•-•-------:-----•-------••---- - ---------------•---------• $ `.. Phone .._ Contractor's Name------_------II _ Installation will serve: Resiltlence Apartment House Commercial [] Trailer Court ❑ Motel ❑ Other ❑ t ILot size ----1�---X-119--r Number of living unites: __!.- Number of bedrooms -2— Number of baths _� -- --------••--------•-- Water Supply: Public systl mjX Community system [I Private ❑ Depth to Water Table !1l-?. `ff. Character of soil to a dept of 3 fil eet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C] g FHA/VA: Yes E] No Previous Application Made: (If yes,date_------------------) NOX New Construction: 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_-______._.-______.Materia--------------------------------------------- Septic _______-__.___._________------------ -----"- l �/ No. oflf(compartments---------- ---------------Size--------•-----------------------Liquid depth--------------------------Capacity---.-------••-------•-- Dlspc c4 Field: Dist, e' from nearest_well_._--_..._____._.Distance from foundation____________________Distance to.nearest lat line._______._____._. �(y Number of lines� -----------------------------Length-of.each line Width of trench.}-. t Type of filter material______--__--j. ---_ -Depth of�flter_material-----------------------Total length__---------•-----_---•------•-•-------- v ACU / ,fQ_.:..__:DistaF�e to nearest lot lin _ Seep ge Pit: Distan-e to nearest'weil___ ._ o�/�-_"Distance•from founda#ion.__ _ Number of pj+s-A-/--------- ----Lining material--------- ,v5ize:tD'tameter__ ,%---•-----:Depth___ ------------------ .. �. Cesspool: Distance from nearest well----------------i-Distance from foundation--------------------Lining material--------------.________________.:-.Is.. ElSize- Diameter- �` ` ---Depth---- -----------------------------------------------Liquid Capacity--F--------•------------ ;-ga Privy: Distance from nearest well40 % -_.�-t.-------------_____-______---.___----_._.'_._Distance from nearest building------------------------------------------ ' i ------------------------------------------------------•-------- ---------------------------•------------------•----------____-- o Dista i ie to nearest lot line______________ t .,� Remodeling and/or repairing (describe} 2,,,4_T:� ------ -------- ------------ -------------- --------- ----------- � - ------- ---------------- w � ..---- -------------- ? = __ ----------------------------- I:hereby certify that�l have 7ndre I this application and that the work will be done in accordance with San Joaquin County ordinances, State la and les lations of the San Joaquin Local Health District. (Signed)______________ r .� "` 5 -- ---(Owner and/or Contractor --- T----- a - - ---- the-=-- --- By:---------------------------- -------••------- } (Plot plan, showing size 01 lot, location of s ei elation to wells, buildings, et ., can be placed on reverse side). uu FOR DEPARTMENT USE ONLY ip DATE �/------------------- APPLICATION ACCEPTED BY_.-----._y.-- I , DATE------------------------------------------------------------ REVIEWED BY----------------- ----------- BUILDINGPERMIT ISSUED.----------------•--------------•--------------------------------------------------------------------• DATE------------------------------------------------------------- '1�and/or recommendations:---------------------------- •---------- ---------...-------•-- ---•---------------•--------------- -------- q ---------- ----- ----- ----- -- - - - --5' -----------------------------•------------------- I- ------ ----------- ----------- ------------ til ------------------------------------------------- - - ---------- Date FINAL INSPECTION f � I. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California I Locil,California Manteca,California Tracy,California E 6.9 REVle EO e•69♦.P.00.SM 19.60