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FOR OFFICE USE: -----------f--- - ------------------------ -- // --; --=-� -_7�1.6� APPLICATION FOR SANITATION PERMIT Permit No. _.. T.-----: - -�-------------- ---------------------- -- Com late in Duplicate)_ ` - _ ., ..�.. Date Issued --------1 _--- -- ------------------•--------------------------------- --_- This Permit Ex ices 1 Year From Date Issued' M 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. Qa c{_ D3�_ 0--cr'o iso"�,.• . - , tc�5 JOB ADDRESS AND'L ATION ; Ab ------------------------------------ �...... f .t ---------------- -•---- .....----- Owner's Name--------------- ---- . Address............. . .....-- Contractor's Name iql.Ne--------------------------------•-----... --_----••. ------------------- Phone_.;. .. !`fA r Installefion will serve: Residence ❑ Apartment Houselo Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i . Number of living units: _ f---. Number of bedrooms _- Number of baths . .-- Lot size _... . Water Supply: Public system E] Cmuriity system ElPrivate N Depth to Water Tble..;Fi7_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [K Hardpan ❑ Previous Application Made: (If yes,'date--------------------) No (( New Construction: Yes No ❑. FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permi#ed if public sever is available within 200 feet.)a .. l Septic Tank: Distance from nearest.well--/SV.......Distance from� foundation-- Material-- i� +_- ;�,-e_-----_--.-----. No. of compartments----X---------------$ize> _--�-�-� --------Liquid depthSo..S_ Disposal Field: Distance from nearest w IL- - , -..-.Distance from foundafion..40S--.--_---Distance to nearest lot line,_--..... Number`of lines.__--------- )) = [�--` Le g#h of each line-_/.0.4 Width of trench-.-- --------------------- Type of'filter.material-_ -- Depth,of.filter material---1- ---____-_-_Total length----_�Q�- ---------------------- Seepage Pit: ! Distance tolinearest well A�:_79 ----_-Distance from foundation-- P-4-._..Distance to nearest lot line--fD-�--.- a... ' Number of pits_.-_'�_-___Lining matenal_� __�Ql'I�Size: Diame#er-_�-�-----..-__Depth--.�.�-�------------------- Cesspool: Distance from nearest well_`--- -------Distance from foundation--------------------Lining material--.-----------------------.--_-------. ❑. Size: Diameter-------------------'-`-- -------::7:--De th----_-------------_ Liquid Capacity --gals. Priv }Distancetfrom;hearest�welL_-------- ----- -- y: ------------- ----------Distance from nearest building--r-----_-•------------------•----•----, ❑ Distance.to Wean est lot line------"9------ "-----------•'=�-----•------------------------------ -- LL Remodeling and/or repairing (describe): ------------ Q ---------------------------'------------------------- g'T..t . T� l .----- .-1� X11�.�., - Pr L11��-' '. 1 7t------------------- . ti - M --------------------------------- ---------------------------------------------------••----•--••----------------------------------------- ----- I hereby certify'that l have prepared this application anis that the work will be done in accordance with San Joaquin County ordinances, State laws,�and,xules and regulations of the San Joaquin Lacal Health District. , r {Signed} -- -- -- ---� -` ----- -- ------ --------------------------------------- wner and/or Contractor) TitleBy: -u--- - - ---------- - - -A----------------- ------------ (Plot plan, showing size'of}lot, location of system in elafion.tc; wells, buildings, etc., can 6e placed n reverse side). .,�. FOR PARTMENT USE ONLY APPLICATION!ACCEPTED BY _ - -•--------------= --- DATE-------- � = - REVIEWEDBY-•----------------------------- = ._ _.-----------------------------------------------------------• ••------. DATE ail �." BUILDING PERMIT ISSUED ' - - DATE Alterations and/or recommendations: -------------------- �Lr ' 9--r�--= ----------------------------------------------- - ------------------------I------------------------------ -----•-- ----- ---------- ---------------- ------I---------- -------------------------- ------------------- ----------------------------- ------ ------ -------- ---------------------------------------------------------------------------------------------------------------- FINAL INSPECTION "B ----- ----------------- Date- '. �' 40 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South A erican Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California ,o Lodi,California Manteca,California Tracy,California t s EH-9 REVISED 9.59 F.P.0 C.2M S•69 }