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FOR OFFICE USE: // Permit,.No. ..��:!�.�- APPLICATION FOR SANITATION PERM .: (Complete in Duplicate) Date Issued . -----_�--- ----- ---------------------------_-- � This Permit Expires 1 Year From Date Issued Applica#ion 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. j JOB ADDRESS AND CATIO --------- -- --- -- _-• ---- -- - - t_n F hone ----------------- I - - - , Owners Name----------- - ----- Address • --------------------- ;* ------------ - ". --------- Phone.----------•----------------------- F' { Contractor's Name ---------------- u -------••-------------------------------------•--- Installa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + yy .- t Number af.living units: --- -_ Number of bedrooms 4----__ Number of baths _f._____ Lot size .... .. fel--� __ .. ....•-----------•-•- Water Supply: Public system:j ' Community system ❑ Private ❑ Depth to Water Table : .-_ ft. s j i.,t Character of soil to a depth of 3 feet: Sand El Gravel [I Sandy Loam El Clay Loam ❑ Clay ❑ Adobe [ Hardpan C] Previous Application Made: (If yes,date--------------------1 No New Construction: Yes No ❑ FHA/VA: Yes ❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS:; (No septic tank or cesspool,permitted if public sewer,is available within 200 feet.)r Material: Septic Tank: Distance fromInearest well -Distance from foundation. ---. --- j No. of compartments----_---r --------- Size__.-- - - J�-Iiiquid d�th ..---- ' - ---.CaPaci#y..- ---- Disposal Field: Dista nce,frarrlrnearest welF�t' a'R .Distance from foundation__ —0- -:--7--Distance to nearest lotjine-------- Disposal _- .- I Number of lines.__ __ -- ______Length of each line. f'-- - -----Width of trench_-_-_$-.__--_4�---.3 Type of filter material-p,._ - ___ epth of filter �natenal__ _ ____________Total length___'•----'3- ------..------------_----� T- �..t : -- ` Seepage pit Dis#ante to nearest well_________________-_-_ istance from foundation.'___...__.______.__.Distance±o nearest lot line-----------------Cif Number of pits-------=--------------Lining material-----------------------Size: Diameter--~___t-`"------Depth-------:---------_----•--------•� Ces pool: Distance from nearest well:---.-- _-.-Distance from foundation___________________Lining material__.-_--_-_______---.------------FIs. ❑ Size: Diameter--------'----------------------------Depth'=----------------=----------------•----------------Liquid CapacitY----------------------------9 - -- °, _- ------------ Privy: Distance from nearest well---------------------------------------------- -Distance' from nearest building-_ .� - -------- ------------------------••----- --------------------- Distancert - } r f to nearest.lot line----- -------- ----- Remodeling and/ 'r repairing (describe):;..ri'�G-CIAI _---,--- g � -- - ---- --- p p - -------—_-_pp------- s-J-[-_..-r---'---------- -_`.----"-----`-------_} ulations of the San Joaquin Local Health District. y 9 ; h=San Joaquin County t I herebycertify th'af I°IilTave ; eared this application and---------- that the work will be done to accordance wit !-- ordinances, State laws, and r les and r � Own C, f/ �. .. .r -------------------- __,r --- ------------ (Owner and/or Contractor) Si ned ' J' --------- ------------------ ----------------- ----- ---- =`= . �.",- . , 4_ placed, 5 (Plot plan; "showing size of lot, Iona+iorrof sys+em in elation.to wells, buildings, etc., can be }ori,revere side).' 3 FOR DEPARTM'ENT,USE ONLY APPLICATION ACCEPTED = '' REVIEWEDBY----------------------------- - r- _ - ----s---- ---------------- DATE. -------•-` ".. _ DATE----- BUILDING PERMIT ISSUED_____4_____ __ = -- 4- I = ± ____ _ - I ':-----_---- -- ----- ------- Alterations and/or recommendations•__ = { ` - ------ ---------------- ----------- -- ------ ; ,.,: ' _ _ _ -------- ----- _ �t s .._ Date.------------------------------------ ------- ----------------------------------- FINAL INSPECTION- BY-----:......_:.... .. SAN JOAQUIN�LOCAL HEAL H DISTRICT t i 130 South American street < 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Callfornia Tracy,California r EB-9 REV{BEb B-89 r.P,CO.1M 6.60 -