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. r � FOR OFFICE U E: 4-a APPLICATION Permit No. rsl •1--�� - _ APPLICATION FOR SANITATION PERMIT (Complete in Duplicated Da+e-Issued _ _-- --- -_ ___.___" This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. w This application is made in compliance with County Ordinance No. 549. } JOB ADDRESS AND LOCATIO ' 6's -- _ 1 t Phone----•---------------------------- Owner's Name----- wn"o----------------------------------------- ----- --------------- •--------------------------- ---••-------------•--.....--•------- ---•----------------- Address-- Phone --- Contractor's Name------------------ r ' Commercial Trailer Court ❑ Mote! ❑ Other ❑ rtment House ❑ Ci Installation will serve:,. Residence pa ❑ Number of living units: --/--'.!Number of bedrooms Number of baths J---- of size--------------`_-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ Wit. F Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ PP y,t' FHA/VA: Yes ❑ No 0— Previous Application Made: (If es;date-----------_--------} No New Construction: Yes o ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . ..,, 41, _Distance from foundation--/4?. vl Septic Tank: Distance from_nearest well. / Ca aci# OO No. of.compartmen s -Size--__ Xu`- 7----------- depth--- y_.._._ ._ P Y x --- -� r Disposal Field: Distance from-nearest well. -P":Distance fr&ri lfoundatio 5.:----•=-=--Distance'to nearest lot line.l4_ _...-__ f Number of lines___.----- r -- -------------Width of trench__�e'._.__.-.----•-----_--.-- J -- -- --_-- - Length of each-i�ne_____-- _-- - ".a _ `r Type of filter;material�ff_C -- .__Depth.of fil#er'jmate al - __a___�__.___,_To#al length_;__: �--=----•------- f Seepage Pit: Distance to nearests.,we l s -------Distance from/�oundatian---- -------------Distance to nearest lot line__ -_-_..- -------Lining material_ 7-.0-- --- .size: Diameter-7...------.Depth---.0------------•------------ NO Cesspool: Distance from neares well_________________Distance from foundation_.-__._______.-___..Linin g material___.____________________._____...___ � Number o pits____ _________ ❑. ' --=--------------=------------ -----Liquid Capacity.------•--------------------gals. DI stable from nearest ______.___ _pe------------- - ---=--Distance from nearest building------------•-------------•- Depth-----. Privy: - _ w. - i ----•- - •----------------------------------- - -..w ^^ ; ❑ Distance to-.nearest lot .line---------------- ----- -- ------------------------- 41 g /Z?c_ �-4, Remodeling and/or repairing.(dostribe):____ --- - ---0 --- ___________________ _ __________________________________ f - 1 y_£ � ______________________ ---------------------------'- -----'----•----------•-'-------------- ----------------'---------------------------'------------------------------. ------------• ---•--------_._ ! hereby certify that'Fhave prepared this application and that'the work will be done in.accbrdance with San Joaquin County ordinances, State laws, and rules nd regulations of the,5an Joaquin Local Health Ditfrict. y t [ -----------------------------------------------------F Owner and/or Contractor) (Signed) -- --- -----•--,---------- ----------------------- t ---------(Title)---- ---------------------- ------------ - ----------------- By:----- '--- ----` --•-----•------------•---------------------------------------------------------- --------- (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY > ---------- DATE.: __`. s'�`' -------------------- -- APPLICATION ACCEPTED BY__ --�- ---------. , :_C&_: - REVIEWED BY------ '�'�-. -�,.�T>`¢ = = .DATE_ - = rr ------------------------------ A7E BUILDING PERMIT ISSUED-------------- ---.------- -- ---- - --- ---- --- -- ------- -------•- Alterations and/or.recommendations:------- '' ------------------------------------------- -------------------------------------------------------- -_-- -------------------------------- s _ (---^--- ------ -------------------------------•------------•- FINAL-INSPECTION BY:-----.-.-r-----=-------�- ��' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3001We124 Sycamore Street 205 West 9th Street Stockton, Oak Street Y . Stockton,California Lodi,California Manteca,California Tracy,California i EB•fl REV�9 EO e•59 r.P.c O.2M 6.60