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rUKOFFICE USE: - ----- -----—- - - -------- APPLICATION FOR SANITATION PERMIT Permit No. --. & - ----------- ------ -- - (Complete in Duplicate) / .. - This Permit Expires 1 Year From Date Issued Date Issued _11443 Application is hereby made to the San Joaquin Local Health District for a permit t construct and inst I the work herein described. This application is made in compliance with County Ordinance No. 549 30000 s -��s GInJ 2A ct C`j r di" JOB ADDRESS AND LOCATION._S -.-- - t Sf,. Owner's Name--- - �� Address-'---�8 ` - -a � 2��.. _�cr n ----_rl�. ----- -- ---- ------- �/� --- Contractor's Name_ - --. Phone.fi!0---�387rf I - - -- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1.-_ Number of bedrooms ._�_(L Number of baths -_1... Lot size Water Supply: Public system E] Community system 40 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Send Loam ❑ Clay Loam ❑ Cl y ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_._.._._._.---I No New Construction: Yes to ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / , �J Septic Tank: Distance from nearest well.!-�0..-.Dista��fomOf�unda}ion-_-1.(�._......Material_�:.4w'.�.L�s,at_-C.._C,�-_, gNo. of compartments......-..-._._Size...-.y. .p.-..X.�...Liquid depth----- .�------._.Capacity-.L?eO7..�s�. S ,• t� if Disposal Field: Distance from nearest well_-1re...Distance 11 founda}' n..._�.Q Distance to nearest lot Number of lines..-.-. ... Length of eacT e../ 7yWidth of trench.-A for Type of filter material.-.- .. ..._.._. Depth of f Iter material__..._ --__Total length-------------------- -Q Seepage Pit: Distance to nearest well. .Distance from foundation_.------------------Distance to nearest lot line.........-.-..._ ❑ Number of pits------------_-__Lining material----____-----------Size: Diameter----------------- -----Depth-_.-------------.-------- .--_. Cesspool: Distance from nearest well-----------------Distance from foundation-__-.___.-------.Lining material---------_---_-...._----------- -- ❑ Size: Diameter----------------------------Depth----------------`---------------------Liquid Capacity--------------------------gals. t... Privy: Distance from nearest well- - ------ ------- --------------Distance from nearest building_....._-.-.___---------__---___. ❑ Distance to nearest lot line..-------------------------------------....--------------'-- ---------------- N Remodeling and/or repairing (describe):........ /L-- --_ -------- ------- -. � yt-_-_------ -'-----------'------_ p ---------------`..--------------...----'-------`------------'--------------------------------------'-------------- __.---------------------------------------'----'----------------------------------------------------------------'--------'----'-------------------------------------------------'------------------ t I hereby certify that I have prepared this application and that the work will be done in ae rdance with San Joaquin County ordinances, Staf s, and rules and regulations of the San Joaquin Local Health istrict. (Signed).. \ , By: ----"--------------------------------`----- --- ------ -- -- --- ----- - (rifle) - - -- ------- ------- — - .... (Plot plan, showing size of lot, location of system in reletio +o wells, buildings, tc., c n be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --------------------------------------------------- -........ --- DATE--------------------'__----------------------------- REVIEWED BY ------------------- DATE------ ' //------- ------------------------------------- ---- -- BUILDING PERMIT ISSUED....._.._ ----------------------------------------- ---- ---- DATE -------------------- ------ - -_ ................- ....------ -' Alterations and/or recommendations:--------------------------------- = ---------------------------------------------------------------------------------- / ------------------- ---------------------------------------__--------------------------- '-- ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------'--------------------'---------' - . ......... ---------------------------------- - -------------------------- ----- ------------- ---'-- ..--` " ... ------- -------------------- - ------------I.......... - - FINAL INSPECTION BY:----------------_ :, cx J� Date ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Haaelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'ED 1.1,.0.