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t-UKUr-HCE USE: ------------------------- ------------------------------- APPLICATION FOR, SANITATION PERMIT Permit No. .±127 ---------------•------------------------------------------ (Complete in Duplicate) ----------------- -- This Permit Expires 1 Year From Date Issued p(p 1—o Date Issued ..... p-3o Application is hereby made to the San Joaquin Local Health District for a permit to construct and in +h Fork herein descr'bed. This a plica#ion.is made in_compliance with County Ordinance No. 549. JB ADDRESS AND LOCATION_ _ �.}•• S -• h4 �Z Owner's Name . .._--•------------ Phone......•-•--•--••----------------- Address sC Lam, -,c.� ------------------------------- -------•-------........................................ c � Contractor's Name._t4 .c. __.__ -- . K-----4 ----ri�. 12I'._�� ...y A 0— Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel El Other ❑ V . - Number of living units: •_�____ Number of bedrooms _ -- Number of baths _f_!1�ot size .----Y- ............................... L Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table`•f 0 ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe I Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ Idl ❑ Previous Application Made: {If yes,date------------.-------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------__.-Distance from foundation--------------------Material.......................................... ._.._. ❑ No."of compartments Size-----_-•--------------•------Liquid depth--------------------------Capacity.....................k Disposal Field: Distance from n'earest well____'-____._____Distance from foundation________-__----___.Distance to nearest lot line................I F El Number of lines-------------- of trench_______________________...........A _ - ------------------Length of each line------------------------- . Type of filter material-___ ------------------Depth of filter material-----------------------Total length-----------------------------._____--._.-_ { I Seepage t: Distance.to nearest well-------1_fl.C_-_____Distance from foundation-----IQ..-.._.-.Distance to nearest lot ........ Cesspool: [ � Number of its----._- `r' ' j k p� ------•-•--Lining material .f}r�. .__.Siza: Diameter-------- �-----_.Depth------��.-_._--•---------- Cesspool: �"Distance from nearest-well_________________Distance from foundation--------_...........Lining material----------------------------.________ ❑ Sizer Diameter_-.-.-_-::----------------------------- Depth..._` - Liquid Capacity gals. i '..rte -e ,e Privy: Distance from nearest well-"---------------------------------------`'_,-__`.Distance from nearest building--------- ❑ line--- 3 -�. ., Distance to nearest lot = - ----------- =9------------------•-- ------------•-----------•----------------•-----•--------------------- 9 (describe): r re airin ----- F --- _'d- --------------------------------------------------- 'd-{'` rte) P -----t ---------•----•----•----------- -- ----•-- } _? ........IE.....y........»•---.......•------"-----'-------........-------------•----•--------...•----__.-----•------..'-----------•---------•-------».---------••---•------• ----_-•------------------I------------•-------------- -l--..r.......---•--•-----.._..___........: ..._. ----- --._....---..»--...____...--------------____..-...-_.. I hereby certify that I have prepared this application.and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaq ' Local Health District. u r S.r --r �. r.t, J p (Signed)--------- -•------- 'o' :.---- ---- 'y" #�----• '1.''t _ ° , ( an /or Contractor) BY:--- !�- - -. � ....Arifle) ) - -------------------------- �{ P- = - _ Y :_t -... (Plot plan. showing size of lot, location of syste� in relation to wells, buildings, etc., can be laced on reverse side. FOR DEPARTMENT USE_ONLY_ ----_____� ) APPLICATIONACCEPTED I3Y-------- -------------------------------------- -- ---•-----------------------------•-•------- DATE----- --•---------------- ----- ----------------------- - REVIEWEDBY------------••--_--------------------- -----••-------------------------------••------------------------------•----•--. DATE------•---- BUILDING PERMIT ISSUED -`' ------------------------------------- --------------------------------------- ------------------------------••--•--- DATE---------- Alterations and%t5r recommend'atlon:iN_---f------------------------------------------------------•------------- y --------------------------------------------- ----------------- Y---------" --- ' f -------•----------•----------•-------------•---------------•------••-----------•-------•••-------------- •••-_.... ----�-•- - -------••----=------`------- ..- •-•---------------------------••----------.. --••-----------.--_.------......._-------------.--- ••------•-•------•-••---------- r -..-•------------ --- ------- ------------ •• -------------------- --------------•-------------------- --------------------------------•--.. -------------------- ............... FINAL INSPECTION BY-- ------- --- -- - -- --�f —� — . ----- Date -------- -- ------•---• ----------- ----------••----------......... SAN JOAQ IN LOCAL HEALTH_'OISTRICT;' 130 South American Strut300 Wsl Oak Streif * ca }Y'I )%,ki 24 Sycamore sirie!t 4 � 205 West 9th Street d 1 Stockton,California Lo ,Ca1Iforn[a Mantua,California Tracy,California ES 9 REVISED B-09 2M 6-61 AT4Ag L