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n FOR OFFI U E tt - ' fel---- 1 'PermitNo. _..l. �� . � :APPLICATION FOR SANITATION PERMIT --------- .� (Complete in Duplicate) - Date Issued _____ ----- --------------------------- -------------------------- ----- - ------ This Permit Ex ires..1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct-and iib 'install the work herein descre . This application is made in compliance with County Ordinance o. 549. T I I ..... .. - JOB ADDRESS. AND LOCATION.__ _ 21------------------ 77 Owners Name_._.___ ____.-.-•••-- •------•-------------- ------•-------------- ------- Owner's Name .......... ------•----------•-------------------- 9 ---•---------- - ` ! , Phone- _------------------------- Contractor's Name__________ ___ _ __._.. __..____.._..=. - --- - - ---- Commercial Trailer Court ❑ Motel ❑ Other ❑ A artment House ❑ ❑ � Ins+aliation will serve: Residence p .__ Lot SIZE _ ---•--•--------•----•----.._ Number of living units:,.3{-- Number of bedrooms �Pc Number of baths _,6__ Water' Supply: Public system ElElCommunity system Private F1 Depth to Water Table -------- ft. Clay Adobe —Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam ❑ ❑ Previous Application Made: (If yes,date---------------- No [y New Construcfion: Yes ��10 FHA/VA: Yes E] No 1�3� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sedank: Distance from nearest well__-_-._-.____---Distance from foundation___________________.Material_._.__._.____.--n - --: - -- p Size--------------------------•-----Liquid depth----------------------- Capacity 4 :: r No: of compartments------------- i,. Disposal Fiei Distance from nearest well_________________Distance from foundation___--_-.._._-____.--Distance to nearest lot line..--___-_-.-_---- t � Number of lines---------------------------------=-Length of each line------- Width of trench l� Type of filter material-------------------------Depth of filter material-----------------------Total length-----•-----•---------- . � .. .. Distance fr m foundation_.- --------Distance to nearest lot line_SJ_.___-.- Seepage Pit: Distance to nearest well _ . ____ i -Lining material---_.-- fq----Size: Diameter--4/?,------- --.Depth_:_- ----• . Number of pits---------,-------- ❑ d _ ._ __----.------- -- essp ol: Distance from nearest well-----------------Distance from ounao .-.--_-___--------- g material _ g als. Liquid Capacity------------------- Size: Diameter---------------- -------------- :Depth Distance from nearest building ' Distance from nearest well----------------------------- ---------------------------------------------------------- -4-Prlvy: -----•---------- -- Distance to nearest lot line___________________________________________ t .. , . Remodeling and/or repairing (describe):--------------•---------- ` i --------------------------------=-••--- ------------=----- ---•-- - ------------------•-------------------- -------- -------------------•-----------------=---------•-------------------- I hereby-certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and r gulations. of the San Joaquin Local Health District. ,. __ __________(Owner and/or Contractor) t ( g ed)------------- ---------------- ---------- ---------- ------------------------------------------------ f -- ------- --- -- - - - (Tit ,.,, in - ---•- --------------•------ - ---- - (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED ----- -- =----------------- DATE � � f DATE------------ ------•--------------- REVIEWEDBY----------------------------------------; ---- ;; D ATE ,------------: ----------------------- BUILDINGPERMIT ISSUED--------------------------------:----------------------------- ',------------ Alterations and/or recommendations:___.:_-.. _._._.- -------- •------------------ ---------------------- --------------------------•- = ----------- ---- - ------------------ ----- ' FINALINSPECTION BY ------- ------------ -- ` - ------- -- Date------- ---- f SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 1 Z4 Sycamore Street 205 West 9th Street ' 130 south American Street Tracy,California Stockton,California Lodi,California Manteca,California a E9.9 REY16E�8-59 P.P.Cr].1M 8.60