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FOR OFFICE USE: 17--------------- 5-•Permit No. ------ APPLICATION FOR SANITATION PERMIT ---- -- -------------------------------------- --------------------------------------------------------- (Complete in Duplicate) Date Issued --------hlI, ----------- ------- - ------------- This Permit Expires I Year From Date Issued -70--0/ ----------------- 2- 0 Applica-tion 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 complian.-ce with County Or finance No. 549. 'AND .... ---- _%O ADDRESS4, LOCATION-1!4 __ _441,1_A---- -x ----- ------- ... Phone- owner's Name ---------------- ---------------------- ------------- ------ - -- ----------------------_------------------- ------------------ ...................... .................... Address.-..-. --------- Phone..Contractor's -------------------- Contractor's Name-------- - - --- ---------------------------------------------------------------------------------- I [I Installation will serve: Residence-[] Apartment House El Commercial E] Trailer' Court [:] Motel Other, --------------------------- Number"of living units: Number of bedrooms Number of baths Lot size Water Supply: Public system El Commun�ity system D Pfivafe R��Depth to Water Table. r f} / - i. 01 Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam M"-Clay Loam 0 Clay Ej Adobe C] Hardpan ❑ Previous Appli6ation Made: (if yes,date---------------__) No gj--'New Construction: Yes [?'Co ❑ FHA/VA.. Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if `c sewer is,available within 200 feet.) L --------- Septic Tank- -P Distance from nearest kU419-------Dista ,foun ,�ation.____1159_--_-_-.-.Material-- --- No. of compd'rfr - ----------- -------SiZO g .--Capacifyr.;?% __22_4��__ W 6) .. 4-�_ i�uicl dep*,607_11--- Disposal Field:` Distance fromnearestwell_i;0�------Distance from foundation----14-1-7.."_.Distance to nearest lot 'V —fdth of trench- Number of lines:1_14----------------------------Length of each lin _jW -7 �70 -------------------------- Ii .� V� -- 4.44-Depth of filter material_,/,'P!�..........Total length_,.��,49............---------- Type of filter materiial_/ok Seepage Pit: Distance to nearest well.-A r.-Distance from foundation_,,;�, --------Distance to nearest lot line--4--------_ _.Zip-------------------- Number of pits_,__,�&-------------Lining material--, V6�-,,Size: Diameter------- --------------Depth Cesspool: Distance from nearest well-_--------------Distance from foundation ------------------ Lining material_-------t_j-------------------------- El 'I Size: Diameter-------------------------- -----------Depth---------------------------------------------------Liquid Capacity__------------- ----.-.-.gals. Privy: -Distance fromnearest well-------------_----------------- ---------------Distance from nearest buiHinq---------------------------- ------------- Distance to nearest lot line----------------------------------------------------- -------------------------------------------------------------------- ❑ Remodeling and/or repairing (describe):------ -------------- --- -- -- r-----------------------------...-------- ---------------------- -- ---------------------- ----- ------ ----- ------------ ------ - ----- -- ---------- ------- -------------- ------------------------ -----------=----------'_ -------------------------_-____moi_--------- ---- ------------------------------------------------------------- -------------------------- I hereby'certify that I have prepared this application and that the work will be done in accordance with San Jo aquin County ordinances, State laws, and rules and regulations of the San Joaquin, Local Health District. -�or Contractor) ----------------tQQF!E!EW! (Signed)------ - -- ------ -- ------- -- ------------------- - By: ---------------- ------------_ -- ---------------- e- -- l - ------------- ------ --------- - ------- (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------ ----------------- APPLIAPPLIMATIONN CATION BY------ ------ - ----- ---- ----------------------------------- ------ ----- ----- ---------- DATE------------------------------------------------------------ REVIEWED BY----------------------------------:---- --------- -------------------------------------------------------------------- ------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------- --•----------------------- DATE------------------------------ Alterationsand/or recommendations:-------------------- ---- -------------------- -------------------- -------------------- --------------------------------------------------------------------- i ----------------------- -------------------------------- ------------------- -------------------- ------------------- ------------------------------------ ------------------------------ ------------------ ---------- -------- --------------I------------------------------------------------------------------- ---------------------------------------------------------------------------- •-------------------------------- .L ------------- ---------------------------------------------------------------:--------------------------- --------------------------------------------------------------------------------_1------------------------------ ----------------------------------------- --------------------------------------------- ------------------- --------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. J-11--4) ----------------------------- Date------- ----------------------------- ---------------------------------- 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,';Callfornla Tracy,California E9-9 REVISED 0.50 F,FXM 2M 6.60 6