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u FOR OFFICE U E: ---- -.-_ -r_ - - - _r----�A, APPLICATION FOR SANITATION PERMIT Permit No. ...�1- 1. --------------------------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .-- Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO�ATION.-�_ -_Er- /-� ---- r . Q�P +hr. Owner's Name �.-A _._ rJ �L + a....-----•---------•-•------------------------------------- ---------1-1 •------------- Phone.................................... Address '` . tE� ''1.• - ----------------•-----•--•--------------------------------------••---•-------•----•------------------•------------•------•-----•- Contractor's Name_.- , ----•-------•----------------•------•-.------ Phone..........................--------- c Installation will serve: Residence [E'-Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._-{___ Number of bedrooms _3--- Number of baths 4LLot size -----,q,-�----1.9 - --------------------- Wafer Supply: Public system �ommunity system F1 private F] Depth to Water TableaG1�- ttt. Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Clay Loam �al y ❑ Adobe❑ 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 permitted if public sewer is available within 200 feet.) _ SepticTa Distance from nearest well fSoa --_-Distance from foundation-/4!-------------Material—-------------------1------- --- No. of compartments---------2------------Size------r. Y1xx G_.---Liquid depth__-_ -' '----------------Capacity-_----91:?-119—'( Disposal Field: Distance from nearest welly---Distance from foundation-/.0--- r---------Distance to nearest lot Number of lines----_ Length of each line-_-7 _ --9 `1JNid#h of french------Ak' ------------�-- Type of filter material--- -----_-Depth of filter material----fV"__------------Total length----_-_-- ..-ra� �-_...-_ Seepage it: Distance to nearest welly!ltd�C--------Distance from foundation--/.a-e! �+"e--. istagce to nearest lot line-¢--I-_...... ��' Number of pits.-.---:�------_Lining material--�t?C-f----.Size: Diameter---- Depth_----1a- .---_------- [�1 Cesspool: Distance from nearest well-----------------Distance•firom foundation--------------------Lining material..--_-_--._-_-------_--------_--_-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_-----_---------_-----__--------------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------••-----••---------------------------------------------------- Remodelingand/or repairing (describe)---------------- -------------------------------------•-----------------------------•-••------...-...-•------------------•----------------------- -•---- c -- - --- - - --------------------------------------------•••--- ---•------------------------••---- ---------- 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 regula ns the San oaquin Local Health District. (Signed)-------------------------------------------------------- ------ --------- ------ ------------- -----------------------------------------------• ----------.(Owner and/or Contractor By:--•---------------- ----- ---•-- - ---- -- -- -------- - --------------------------------------------------.---(Title)---------------------------------------- - - - ------------ (Plot plan, showing size of lot, location o system in rel Pion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- l ----- - c L2 ----------•--------------- DATE------. " r` ��------------------- REVIEWEDBY----------------------------------------- --- ----- ------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------- ----------------------------- -•--------• --.•_-------------------------------------- DATE-----------------------------------t------------_-----.----- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------•------------•----------------------------•-------------------------•--•------------------------------..-...-----------------•-----------------•-------••--------•--- -----•---------------------------------- --------------•------------------------------------------------------------------------------------------------------------------------------------------ •------------------------- ------------------------------------ ------------------------------------ --------------------------------- -•------------•--------------------•---• -•-----------------------------------------------••---•-•----•-------- FINAL INSPECTION BY:.----- iL -.--A1 C/�-�4� Date-- -------a-�-� ---/_�-- --/�r� � < j . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California E21-2 RREYVI.SrD1�e-99 F.PXCI.2M 6.60