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FOROFFICE USE: I� ---------------- ------1Vf - ( - i _._ �-.__ _ __.. APPLICATION FOR SANITATION PERMIT Permit No. �� . c -�--------------� -4---------- --I?- - {Complete in Duplicate) l --------------------------- II This Permit Expires ] Year From Date Issued Date Issued Application is hereby made}to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafion is made in compliance with County Ordinance No. 549. .._. JOB ADDRESS AND,LOCATION.---------5-&K3, ............................. --•-------------- - 6w.ner's'Name------ =� ---- - cca_Ge:_ �k - -------------------•------------------- -------------- Phone-----•----•----------- Address--------------------!.' ---- 1� 1 �- ----------- •---- -----------•..--------------------- Contractor's ..-•----•---•-------Contractor's Name.-•------==•--I.......� F' I -------�-- fi = ----- - •. ------..-... Phone.....-- ..................... Installation will serve: Residence`JA Apa'rtmentHouse E] Commercial ❑ Trailer Court E] Motel Ll Other ❑ e i. I j / Number of living units: ---Z. Number of bedr'ooms ---I�/ t-- Number of baths Lot size _ 6� r �r. ---. ---•--•-------------------- Water Supply: Public 'system E] Community system ❑ Private R1 Depth to Wafer Table . 6 ft. is . Character of soil to a dep+h',°of 3'feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g] Hardpan ❑ Previous Application Mede:j(if yes,date____ ..........) No 29 New Construction: Yes;K No ❑ FHA/VA: Yes DK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.tank or cesspool permitted if public sewer is available within 200 feet.) w , Septic Tank: pistance�fromfnearest well- Z" from foundation__. � -.--.MateriaL__._ .P _. -_--•. t r No. of do mpar"tments_------.L ------------Siz._.i ._ f-:---Liquid depth--------• � --------Capacity...7' r �f I Disposal Field: Distance from nearest well--- Distance from €oundation_____.j_p______.Distance to nearest lot line____ ___________ Number I Type of lines-----------�--------- -- Length of each line-----7�_-7C�-/ro-.Width of french--------- _ _ � - ------_-_-- yp of filter material_ �- --_Depth of filter material------/9______ __Total length-------------- o ------------------ Seepage _�__._.__ Seepage Pit: Distanc$, nearest well___--�O o----• pistance from foundation__... 7 �=�.D�stance to nearest lot line__-. '�.. _ '� p — i �] Numbertiof pits__- ---, --------Lining maferial_�:_c. _ Size: Diameter------,�.7-----.-._..De Depth........ .5__.-----•----__-- GI Cesspool: {?isfance?'(from nearest well-----------------Distance from"foundation____-----_-..r_--.Gnin;g materiaL _._____F.__...{_ ❑ Size:'piameter--------`----------------------------Depth---•-------------•--------- - Li 'uid Ca aci els. I q P tY ' 9 Privy: DistancI.e;WPfrom nearest well----:_.--.--- ------------------- -------Distance from nearest building.----, ❑ Disfance:to nearest lot line_______________________._______._- Remodeling and/or repairing ----- - (describe) :-- -----------_---------- --------------------------�--_••----- ----•-••-------..•---------•-----•--------------------- ------------------•------------ --••-------- ------------ ----------•--------------- ------------------------------••---•-----•----------------------------•-•---------••----------------------------.----.-.-_-.-.----- -------- w' -- --------------------------- -- - ------------ ------- ---------- -- - ------- I hereby certify 4,V I have-prepared this application and that the work will be done in accordance with San Joaquin County o'dinances, S+ate la ;and ' U and ns of the San Joaquin Ln Local Health District. {5i ned �.' g �- ---- ---- 1, ------'--------------- ---`-------------------•--- ----- -(Owner and/or Contractor) u 18Y� ' ` ' (Plot plan is owing size of lot,locafion-of system in relation-to wells,-building's, etc.;can be placed`on reverse-4id'e). - 4 i FOR DEPARTMENT USE ONLY CCEPTED BY x -DATE . PPLICATI ' - ' REVIEWED BY = �M - = - ---------------- DATE-.---- ---......-----------•-----------------•---- BUILDING PERMIT ISSUED �� ---------------------- T DATE ----------------------=----------- Alterations and/or recommendations:_- �;r -- --------- r: ---- -- -- �., -- '� -- .- -- ------- -- ------'-------------- ------------------- `` FINAL INSPECTION BY i �� Date_ " ., I.- ',SANfJOAQUIN LOCAL HEALTH DISTRICT 130 South American street I 300 West Oak Street 124 Sycamore Street f R 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California d CB•9 REVA Eo 8-39 r.P.CG.9M 6.60