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FOR OFFICE USE: -------------------------- ------------------------------ -vq 9 9y --------------------------- ------ ------- -------------- APPLICATION FOR rSANITATION PERMIT Permit No. ._c --------' --------------- ------------- ------- (Complete in Duplicate) -- •------ ------------------------------ ---------- .This Permit Expires 1 Year From Date Issued Date Issued _.- -%�___(r�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. os"? _ 136-0 J B ADDRESSN LO 'TION. / fk Owner's Name_ Slt &c r. Phone Address _ . .-••------------ a Contractor's Name------- Q. ------------------- ---- Phone ---------------------------------------------------------------- Installation will serve: Residence [I[-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �. Number of bedrooms 3_ Number of baths _ --n Lot size IqA X. Water Supply: Public system ❑ Community system ❑ Private - epth to Water Table /_0. ft. Character of soil to a.depth of 3 feet: Sand p Gravel ❑ Sand Loam Clay Loam Clay I ❑ Y ❑ y ❑ Adobe [lardpan ❑ Previous Application Made: (If yes date------------.-------) No New Construction; Yes No ❑ FHA/VA: Yes ��No ❑ TYPE OF INSTALLATION AND SPEC IFICATIONS: septic-tank or cesspool_permitfedTif..publicsewer-is available within 200,fee,~,]�..y, Septic T Distance from nearest= well_-v -------Distance from foundation /C------------Mafrial c� � No. of compartments--_.2--- _ _ 4 - / -- ----------- ---- -- Size �- r� Liquid depth ---- ---------Capacity.,)-a—ov--•-- Disposal FieI Distance from nearest well..-47?�-----Distance from foundation-/--4 Distance to nearest lot line__. --------------- - Number of __ _______r.-_-_-- Length of each line_- �� / � @� - --.�-..Width of trench---1-------- ------------ ,, Type: --------------Depth of filter material-----_1�''____-._Total length_.cQ, :____--"-----_ e o iter mater Distance from fo ndation_- �_�_,___..Distance to nearest tot iine__ss Seepage Dlistance to pnear st welL.l._�' I number of ...:.....:.....Lining material.. G _-Size: Diameter__43_3_ -----_,De th_, _S:_ ---- - I p /,-- Cesspool: Distance from nearest well__.-.._"___.-__._Distance from foundation------ Lining material-__...-_...............__..- 69 ❑ Size Diameter----- - ------- -------.Depth------------------------------------------- --------Liquid Capacity----------------------- - gals. Privy: Distance from nearest weft___________________-----_._ ----_Distance from nearest building`. 9 --------- -- r-d_ ❑ Distance to nearest lot line - � -----Remodeling and/or repairing (describe):_ ----- - , " .. -----------------•------ --- - - -------- ------- ------ - ---------------------------------- M1` { .. --- ----------------------------------------------------------------------- --------------------------------------------------------------•-------------------------------------------------------- ------------- I hereby certify that I have preperedlhis application and that the work will be done in accordance with San Joaquin Count ordinances, Shaws, and ruf nd regulayte tioonns of the San Joaquin Local Health District. I (Signed------------ - ----------Va. ., ------------------------------------------------------------ -----= -----(Owner and/or Contractor) (Plot plan, showing s ze lot, location of system in relation fo wells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.&-Lr __.-.._ _._ DATE_. .5------------------------- -REVIEWED BY------- - ---------------------------------------- ----- DATE UILDING PERMIT ISSUED----- ----- ------- ---- ------- DATE-- ---- ------------------ ---Alterations recommendations-----------___----------------- --------------------- --------- .............................................................................................................................------..._...._..-._-.---- -.. ...-._._..._-_.....----.---------.-----------.------------------`_---.----._-.--._.-_..--._....------------------..._ ----------------------.-------.......-----.----------........... .fi`--_..--....-----...--....--------------------.------------------------------------_---...-__.._..--_......--_....-.-..--_....__.._..-_....._---.-- -___ ----------------- -------------------------- -- /J Y , /FINAL fNSPECTION BY;,�� ,�— D -_-_ �ate-y V�.-- -------------------- SAWJOAQUIN LOCAL HEALTH DISTRICT w- 1601 E.Hazelton Ave. 300 West Oak Street 1J205 West 9th Street Sycamore Street Stockton,California Lodi,California x. Manteca,California Tracy,California