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FOR - OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- -- ------------------ --- ------------------------------- ----------------------------------------------- ---=----- (Complete in Duplicate) Date issued ............ --------- --------------------------------------- ------------- This Permit Expires 1'Year From Date . Issued 9� 0_tkherein clescri"b Application is hereby, made to the San Joaquin Local Health District for a I permit to 5;onstrucf /I ta All ht wo This application is made in compliancewith County Ordinance No. 549. JOB ADDRESS 'AND. LOCATION. -------------- --------- Owner's .Name--------- i4',11,0�Wle ------- /7-"- eS- ------•------- ------------•- ----------- --------------- Phone .................................... Address --------------- 41-ol -------------------------------- -------------- I ---------- --------- - --------- 'I Z7V — I ------- �6 ....... Phone_,,!�_ -------------------- Contractor's Name ---- �7-=X/9 ..... Installation will serve: Residence Apartment House E] Commercial El Trailer Court C] Motel [3 Other El ;Number of living units: / ----- Number of bedrooms __9--- Number of baths ---- Lot size ---- /j9,6 ..... A-490 ----------------------- _�Ij_ . -, -- A'e I Water Supply. Public -system )< Community system C] Private F-l Depth to Wafer Table"ft. i ... I Clay E] Adobe Ej Hardpan ❑ Character of soil to a depth of 3 feet- jSan Gravel [3 Sandy Loam ❑ Clay Loam E] y Ix Previous Application Made: (If yes,date --------------------- I No New Construction: YesNoE] FHA/VA-Yeso NoElK TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic +ank-' or cesspool permitted if public sewer is available within 200 feet.) Septi Tank:_ Distance from nearest well -,4 — Distance fromoun Z_/64fdation.-/Io -- ------- Material ------- ;R4V�� ----------------------- , ' No. of comparfments_.____.. ------------- Size__ 4:M-.- i ---'-.Liquid depth'_.*X-11 ---------- Capacity ....Sf_D ---5F- Dispo I Field- Distance from nears well..//#A%_Ci Distance from fo'undation.-/99�-f'-'..'-.P'istance to nearest lot lin I Number of lines_: .... -------------- - Length'.of each Ii Width of trench.__,..Z,._4/ ------------------_ Type of filter material-_ s_- ___---"Depth of filter'rnaterial___' -Total Ien9'th____./610 ------------------------ _� Seepage Pit: Distance to nearest.well -------------- ---- Disfantejrpm foundation________`__.. ------ Distance to nearest lot line_________________ ❑ Number of pits -------------------.=Lining -- material--- (_1 --------'_----Size: Diam. eter ----------------------- Depth ---------------- ---------------- Cesspook Distance from nearest well_____________ _ _ Distance from folunclation --------- : ----------- Lining material-------------------- --------------- t Size: aterial------------------------------------- Size: Diameter_--- ----- i --------------------- --.----Depth--.' -------- --------------------------- -------- Liquid Capacity ------------_------------- gals, Privy: I Distance from nearest well-________ -------------- Dista`nZe from nearest building___-______-_----_______________' -------- -- - ----------------- F_l, o�,_ line - - 7 ---------- -------------------- ----------------------------- Distance to nearest -------------- ----•---------------- --- a ----------------- ----------- ---------------------------------------- -------- Remodeling and/or repairing [clescri - -------------------- ---------- I ------------------------------••----•----....•---------- x + ---------------11---------- + t e ------------------------------- ---------------------------------------------------------- ------------------------- ----------- -------- -------------------------------------------------------------------- ------------ I ------- i . 1, -1.. I ---------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------- 14 .. ---------- ------------------------- --------------- ------ ------ 1 --------------------------------- * --------------------------------------------- w ------------------- ------------------------------------------------------- Will be done'in accordance with San Joaquin County I hereby' certify have prepared this applicaf ion'and that the work' ordinances, State laws,' and rules and re ulations of the San Joaquin Local, Health District. (Signed) ------------- ------ -------- ---------------- (Owner and/or Contractor) ---- - ----ole. _fo - 7 V fl3y- : ------------------- ----------------------- ! ----------------- --------- // ------ f (Plot plan, showing size of lot, location of -system in relation to wells, buildings, etc., can be placed on reverse side). 4_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- . . . . . . . . . . . .. - - - - - - - - - - - - - - - - - - --------- REVIEWED BY-' --------------- ------ -- ---- ---------------I--------------------- ------------ BUILDING PERMIT, ISS UED -------_----------- : ------------------------------ I ---------- Alterations and/or recommendations::------.-.----:---: --------- -------------------- ---------------------------------------------------------- ----------------------------- ---------- ----------- F --------------------------- I ------------------------------- ---------------------------------------------- --------------- I --------------- -------------------------- ------------------------------------------------- ---------- --------------------- ------------------- ----------- ....................... - - --------- j . FINAL INSPECTION BY: ----------------------- ---- DATE------------- _;;,1_46 --- / -------- -------- DATE------------ 0 -------- ------------- ------------------- DATE -------------- ------------------------------------- -------- ---------------------------------------------------- I .......... 1-11 ........... I ----------------_- ------------------------------------------------------------------------ _ ------------------------------ ----------------------------- -- ---------------------------------- ------------------------------ Date-- ---------- 3_11_2_140_1 ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stroat 124 Sycamore Stroot Stockton, California Lodi, California MUnIOCOr California C5-9 REViGVD B-59 F.P.rD. 2M 6-613 205 West 91h Street Tracy, California