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FOR O FI -E USE 61 APPLICATION FOR SANITATION PERMIT Permit No. ... ..3..f.10-� ----------- - ------------------------------------------ . ------------------- ---------------------------------- I (Complete in Duplicate) Date Issued :... _�. _ ----- --- - ----•--------.--- .---- " This Permit Expires 1 Year From Date�lssued Application is hereby made'+ the San Joaquin Local Health District for a permit t construct and install the work herein described. This application is made in ompliance{ with County Ordinance No. 549. JOB ADDRESS AND L CA ON---_T (Qr - --- 15 14 ► // Phon 2 Owner's Name --------- -------==-------------------------------------- Address_...:- - ---------- -------•- ��a --------------- *--�•, -y... � l � --Phon .....��7_`_/ Contractor's Name.]_, . - 2�-•-d� h - _ �i -. ----------•-•---------------•--- W , - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r I � Number of living units: .____ Number of bedrooms _Number of baths _4Lot size -------- -.--- -11P----•--------------- Water Supply: Publicsystem�Community system El ❑ Depth to Water Table dit. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ElClay Loam ElClay E] Adobe Hardpan El Previous Application Made: (if yes,date---------------------] No'❑ New Construction: Yes ❑ NoJW, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) .� ._ .._ wry _Distance.from.foundation.---'"'_ 'Material------------------------------------------------ Distance ti# T k{ 'Noof compartments--well.---." Size -••----•----- ----- ---Liquid depth----------- --------------.Capacity----------------•------ y D' sal e 'Distance from nearest well 15* from foundation._Ze------Distance to nearest lot line...c ._.__ t Number of lines--.--- __________ Length of each line___CJ7-49- ---------Width of trench_____ ,�. --------- �, f l _ �j -- Type of filter material____. _-t .._:Depth of"filter.material_____ �_ -,___.Total length__________________sem---- ------•-- i Seepage Pit: Distance to nearestrweil_�!� __.r_-_Distance from foundation..��--Distance to nearest lot line_________________ Number of pits------ -- ----------Lining material_= -- - Size:Diameter___,' _'"_. Depth------ •----------• Cesspool: Distance from nearest weiE..................Distancerfrom foundation--------------------Lining material_-_.__.__.__.______:._-______________ Size: Diameter-------------------------±-------r�Depfh�;i----=-- ` Liquid Capacity gals. Priv❑ Distance from nearest well________________ _____----- ----:---- -------Distance from nearest building------------------------------------------ Privy-.; ___..____________--________---.-------_ Y i ----- ❑ Distance to nearest,lota line--------- ------------------------------------------I=----------------- -------------------------------•---------- f ,r . -- Remodeling and/or re airin describe -- -------------- '<-----•---- ------------- fi ------ •- ----••------------ ----- - • �f.��? ----•--- kR_--------------------------------------------------' _ _ ---------------------------------------_-----------_------•___________________;__..___._____--________ -------------------------------------- - I hereby certify that I have prepare this application and that the work will be done'in accordance with San Joaquin County ordinancelaws, and rules and regulations of the San Joaquin Local Health District, SignedCSIX �� _-------- Contractor) :. //� .If «.. . - (Tit e) By---------------------------------------- - •-------- - (Plot plan, showing size of lot, location of system in relatio wells, buildin s, etc., can be placed on reverse side). .._ .4.. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------`- -- -- ------------ ---- -------- ------------------------------------------- DATE---------- �-ZA / ------------------------- TE --- i REVIEWED BY_ - -_. DATE- BUILDING-PERMIT ISSUED---------=---�----------- - --------- DATE . --- Alterationsand/or recommendations----------------------------------------------------------- -----•-------...------••----...---•----...----••--------------------------------------------- ------------- ---------------------y --------- ••-- ---------------------m------------- Date-------- /----------- ---------------------------------•---- F1NAL INSPECTION BY:.� -- -- -- ----- - --- r` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stfeet Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVI9E9 9.59 r.P.CCI.2M 6.60