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FOR OSI E 115E: rl 1 l � APPLICATION FOR SANITATION PERMIT Permit No. ._/r -.� ---- - --------/--------------- --------------------- - rtt _ lf --------------------------- --------------------------- (Complete in Duplicate,) Date Issued ..L--- -------- ------- ------------_-.----------------- This Permit Expires 1 Year From Date Issued � g3� 4o--I/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de�sc-ribed. This application is made in compliance with County Ordinance No. 549. Not--Yh 4 =�_�,. Sp•S•- JI-[G-(fi.-.)tom �4-t!E r � !.t•�YYi�- '/- 'JOB ADDRESS AND LOCATION �_ +��fL• E`�11f� ------------------------------------------------ Owner's Name--- --------:1 -------- Phone - ...... Addres -_= _ �'� -�4I' ',$__. S _ J--� '.----- '-�`-- -----r- - t7 a ��--� ---- . ----------•------ Phone-,O- Contractor's Name7e___.._ _' lfg Installation will serve: Residence ❑ Apartment House ommercial ❑ Mailer Court ❑ Motel ❑ Other — Number of living units: ----�__ Number of bedroom ._ __ __ Number of baths Lot size ___ ?-- ___ x3 Water Supply: Public system ❑ Community system ❑ 'Private*'Depth ater Table _______ ft. Character of soil to a depth of 3 feet: Sand Gwvel E] Sandy Loam Clay Loam E] Clay ❑ Adobe❑ Hardpan ❑ falai Previous Application Made: (If yes,date_�S- --------] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ OF INSTALLATION AND SPECIFICATIONS:.f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ic T& Distance from nearest well-----------------Distance from foundation--------------------Material'-'----------------------------------..________.. No. of compartments------ -------------- ----Size--------------- ------------:...Liquid depth-------------------------.Capacity-_------------------ tI : Distance from nearest well,.�0-'....Distance from foundati n.. ._ - Distance to nearest lot liin9____ �" f Number of lines--'- -:-- �}}tt----__Length of each line--- ----------------Width of trench ----..�r__ `��----------- l dd Type of filter material E j\_yi-----Depth of filter material 1_2 I len gth--- �oQ__ t_�_____..______.._ O ,y 41- ' Seepage Pit: Distance to nearest well----------------------Distance from foundation____--__-___....___.Distance tonearest lot line_____-..____-.--_ ElNumber of pits----------------------Lining material--------•---------------Size:.Diameter----------------------- .Depth-------------------••----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material------------------------------------ . ❑ Size: Diameter-------------------------- ----------Depth--------------------------------- ------------------Liquid Capacity--------- --------------....gals. Privy: Distance from nearest wel -----------------------------------------1-~_ l- Distance from nearest building__._____________--_______-•--------------. ❑ - Distance to neare t lot e----------- ---------------------------------------------- Remodelin and/or re airin describe :_-- -- ----- g I p g ( ) f- --------- ------- ------- �' •----------------------------------------------------------------------------- --- C Q -- - ----- --------------------------------------------------------------------•---•----------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �- ordinances, St a laws, and rules and reg ons of th�aquin Lo al Health District. rn �` __-- Contra (Signed) I "' - -- ------ -1 -----'-=`~`------------------------------ C11 . ---------------�------ ---- --'--' B (Title) Y•- --------- - --------------------------------- (Plot plan, showing size of lot, location of system in r a on to wells, bu'din s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY-----------------------f DATE--------- -- REVIEWED BY--------------------------------------- - ---LVV ---------- DATE ._ . - ---------- ---- --------------------------------------- BUILDINGPERMIT ISSUED-----------------------------------•- ------------------- DATE.---------------------------------------------------- ----- Alterations and/or recommendations:------------------ --------- ------------------------------------------------------- -----•---•------------••-----------------------------------•----------- _ _ ------_ -- -------------------------------------------------- •------- •• •----------•- ------------------•--------. ----------•--- k --------------------- --- - - --------------------------------------------- -----------------__---------------___---------------------------------------------- IL J FINAL INSPECTION BY:-- ---- - ------- Date _ .. -�---`---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California EB•9 REVISED 9.59 F.P.CO.yM 8 I - J-GD