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FOROFFICE USE: ------ -------------- ----------- - -�, ------------ APPLICATION FOR SANITATION PERMIT Permit No. 3 ---------- --------------------------------------- (Complete in Duplicate) f�7 -------------- This Permit Expires ] Year From Date Issued Date Issued ............:.......... Application is hereby made to the San Joaquin Local Health District for a hermit to construct'and install the work herein described. This application is made in compliance with County Ordinance Po. 549. ; JOB ADDRESS AND ASNr -c d �------------------- - Owner's Name_____________ !-__ -•- ---------------------------------- -------------------------------------------- Phone...................----------------- Address...................... ------------------------- --------------••-----•------------------------•---- - -------------------- - -- ---------------------------- Name-- - - :-:�_:. _.__.Phone----:-...---•----•----------•----. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other ❑ Number of living units: ._f__ Number of bedrooms 9- Number of baths A---- Lot sizema A ----------------------------------- Water Supply:pP r Publicsystem ❑ Community system ❑ Private ff"'Depth to Water Table _t�s - ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay , Adobe W?`hardpan ❑ Previous Application Made: (If yes,date____________________) No (2r New Construction: Yes ❑ `No ®/FHA/VA: Yes ❑ No 91�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) __ ......._;� I' Septic,Tank: Distance from nearest well-----------------Distance from foundation_______._....-.._ Material................................................. may / No. of com artments-r- -------:Site-- = qP -----------Capacity....................... f_ ' DisposalrField: Distance from nearest well._-- _&_.Distance from foundationi---live to nearest to j Number-of lines------------ Length .of eachline,n- -4_`--- ---.Width of trench__ �-.r-.------------------------- Type of filter material. Depth of filter mateal:.____�t�_�----Total length------/�L�--_-------_---------------- Seepage Pit: Distance to nearest well-----/aZp_....Distance f in-a .. line--- 'af� ._.._..Dist nce to nearest lot Number of pits:..___•--________-Lining material. _=Siji{ Diameter._ "____- Depth__-,.�-.s r_ -•,--.______- Cesspool: Distance; from nearest well-----------------Distance from found'tion`_-------------------Lining material------------------------------------- El Size: Diameter Depth -------'------------------Liquid Capacity_------------_---•-------_gals. Privy: Distancelfrom nearest well----------_------------------,_____._____.__-----Distance from nearest building______---________ ❑ Distance=to neares#lot•-line- =- ^rte----,-p--- -------------- �i�D � r . Remodeling and/or repairing (describe): 1 � ---- 1 ------•-•--------- -----------•---------••-•--------------------------•------•---..-------• -----•---•------•-•--------•-•---••----------------------------}-----•----------------- ------------ YY prepared pp !, ------------- ---------------- ---------- ordinances, State laws, and rules and regulations of the San Joaquin Local Health 1 hereby certify that I have re ared this application and that the work will'be done in accordance with San Joaquin County 4 q t 7h District. `Z (Signed) "�s"' ✓ ----- - ` i 1.v $ � --- ----- .--------[ r Contractorl ..... ------ ------------------------------------ -- (Plot plan, showing size 0; lot, location of syste relation to wells, buildin s .btc,, can.be placed on reverse side). % ;VZ L, ' FOR DEPARTMENT USE ONLYk,_-\ APPLICATION ACCEPTED BY------ ---. --- DATE_------ t ` ---3-••--i----------!-�---Z------- ------------------REVIEWED BY ------------------------ ----------------------••---------------.DATE--------------------- BUILDING PERMIT ISSUED - ... DATE_.- --------------------------- A rations and/or recammandations: -------------•.....---------------- ------------- s--••-----•-----------...------•-••-------•---------••----........ -•---•---- .� FINAL INSPECTION BY:.----Ly_l---� --------- ---- -------------- Date------1_7-Z-__-__7>.(_-393- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American'Street 300 Weil Oak Street '? ' Sycamore'l ' 24 , Street. 205 West 9th Street Stockton,California Lodi,California �� s Manteca,California Tracy,California EB 9 REVISED 8-99 YM 6-61:,LAB � :�♦ iy;�, • max. .L � ' W