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FOR OFVUSE: r T APPLICATION FOR SANITATION iraet2MIT Permit No. -__,1........... ---- -------------------------------- --------------- (Complete in Duplica+e) Date Issued ---- � --°- 'r This Permit Expires 1 Year From Date_Issued% 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. ` JOB ADDRESS AND LOCATION�. /-- ---_ - - x Owner's Name----x_7_11 rr� _',----// ----------• --- ---_j Address------.- �, . . ---- -•- ❑ p ❑ Court ❑ Mote! ❑ Other � - InstallatNumber of living _ � '----------------------- will Residence Apartment ouse Commercial Trailer `�__..__'� Number of bedrooms __-____ Number of baths :__,--_' Lot{size*------••-- - 9 z Water Supply: Public system i❑ Community system ❑ Private Depthiter 1a61e __ _.. ft. ' Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ psi n) Previous Application Made: llf yes,date________________._.) No ❑ New Construction: Yes �yNo" ❑ FHA/VA: Yes ❑ No ❑ 1_ TYPE OF INSTALLATION AND SPECIFICATIONS: -. l' sewer'is available within.2 00 feet.) (No septic tank or cesspool permitted if public 1 11 Tank: Distance from nearest well. ._le-_Distance'from foundation _- ---_.Material___-C '�-- ------------------------ Septic _ . No. of compartments ----------- --Size .. _57:. .- _ `Liquid dal?th '' = ' ' Capacity ?- r Disposal Field: Distance from nearest well-�-b.. ..._.Distance from foundation _. ' -.I Distance to nearest lot line_________________ Nu er filter material ��i �C _:__-D'e ph offf lter�ml ate l_ x -=ofiath of trench ---------------------- �., . _ - s Type --- i length ��-------- ' �o nearest well___-----_____--:-----Distance from foundation.= .....__ --.-.Distance to nearest lot,lina_,-_.-_.-_---_-. ❑ Dumber of pits----------------------Lining material------------------ -__�ize:tD.iometer---....___�----�Depth: ---------------------- ----------------- SeepagePit: Distance t Cess ool: Distance from nearest well______________._Distance from Al ----------------- material_-.----.--._-.---__----_---._._____. p ❑ Size: Diameter--- ------- ----- ------Depth--•------ �- Liquid Capacity gals _D-s Vic' from nearest building Privy: Distance from nearest well----------------------------------------------- e ". ---- ❑ Distance to rioarest lot line------------------------------------------------------- °---------- Remodeling and/or repairing (describe)!------------------------------------------------------ --------•-----•-----------------------•---------------------------------------------------------- ------------ -------------------------------------------------------------------------------------------------.--------------------------•-----•---------•------------------------ ------------- -------------- ----------------------------- n -------------------=----------------------------- --------------•-------- I hereby certify that I hive prepared this application and that the'work will be done'in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------(Owner and/or Contractor) By:--- 3 -'---------------- ---------------------------------------------(Ti tl e)_ (Plot plan, sho ing size of lot, location of system in relation to wells,'buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .____. --. ,r 4 ---------------- DATE.----�3--771-32- 1Y .. REVIEWED 6Y------------------------ - - DATE-------------------------------------- ------------------ BUILDING PERMIT ISSUED-------•---------------- --- . DATE. Alterations and/or recommendations----------- -------------------' ----------•----•------------------------------------•-•----------- --------------------------.--------------------------------•-----------•------------------------------------- ------------------------------------------------ i, ---------------------------------------------------------------- �I .--._-_-------------------------------------------__.__ _-_--.__.____..___-_--.__.__._._._-_--._.___.________...._____________._.----------------------------- ! � ------------------------------------------------! P. FINAL INSPECTION BY �-----. .-- ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ', 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod],California Manteca,Californla Tracy,California } re-9 FEVISM H-69 F,F.CD.ZM 6.60 5