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FOR OFFICE USE: --------- ----------__.__._ ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ,�- � ------------------------------------------ -------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _. v:o2_- ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This 6 e a plication is made in compliance with County Ordinance No. 549. 9�,0?p -,O � JOB ADDRESS AND OCATI N_.____3 TW IV 4-�--- ....S'i 1�1 -------------------- q Hof f Owner's Name � --------- =1 ,� �-cam ------------- Phone-------------•------- i Address------------------ / `s__. � (j _.. Contractor's Name------------ ' / --------- -- -------- ---------------------------•---.------ Phone-- Vx1_x. . Installation will serve:IResidence ❑ ,Apartment House [-] Commercial E] Trailer Court [❑ Motel El Other '� " 5-770Dr0,-"Number of living, 77 nits: _ __ Numlo"ei of bedrooms .___--.- Number of baths�_-MrLoe ..__...__/_ ___�-X-7,cpp ,7 1 ' ---------- Water Supply: Public'System ❑ Community system ❑ Private ❑ Depth to Water Table ' ft. -\ ,'Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam❑ �Clay'Loam ❑ Clay ❑ Adobe]� Hardpan ❑ .r_ ., / Previous Application Made: (If yes,da?e_____________ -) No �[ New Construction_'es No ❑ FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:I �+ Septic Tank: Distance from nearest well___6-�_r.__Dista`n�fg from foundation---/�`�__..__.M at _ No. of compartments-..___._. r_._ ____-...Size_7 _X•3 ?S _---Liquid ddpth_.._---;-'v-_----Ca Capacity,/ �- e u f p Y� '-�e--- Disposal Field: Distance from nearest weil....5 -..__._Distance from foundation._-._�0'.__.._.Distance to nearest lot Number of lines------------z�r _---__- ---Length of each line------- trench-------------- - D� Type of filter materiai_s��•_ c -_CX_-Depth of filter material---_--/ZF`f_____.Total length------------------At3 ,'- � r See age Pit: Distance to nearest well-_40-0._-__---Distance from foundation---- -------- Distance to nearest lot line_._I ---------- Number ---- ---_Number of pits.---___--9---_.-------Lining material--- -�- e / Size Diameter.__-•__ -'.--_Deptn---------- J ' Cesspool: Distance from nearest well-----------------Distance from foundation----- Lining'material---_.__.--------___--_--..__--------. ❑ Size: Diameter----- ------------ ------- -----------Depth---------------------------------- N----- ---------Li.quid' ------Liquid'Capacity----------------------------gals. Privy: Distance from nearest well----------------____--------------------------___Distance from nearest biuildin ❑ Distarce to nearest lot line r • 1 --------------------------------------------------------------------- Remode3ing and/or repairing (describe): ----------- == `h11 ------•-----------••---------- ------------------------------------------------------------- - ---------------------------------------------------- -------------------------------------- ------------ �y1 1 i ----_-------------------------------_---------------------- ' _.:_.___-_ __ ._________________._______._______..__________.__.._________._.__._.____ I T _------------------------------------------- ----------------------- 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 regulations of the':San Joaquin Local Health District. ( edSi n 9 ; )---------- -- - -F-- -------� �- _ ---- ----- --- -�---�--- ------------------------------- -----�------ ---- (Owne and/or Contractor BY - 4 --- ------------------- -----(Title)--\ --------- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). M ' 1 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY= ----------'----------- ------------------------------------------DATE----- -- \--------- REVIEWEDBY------------- -------------------------- --------------------------- - ----------- ---------------------------------- DATE-_ BUILDING PERMIT ISSUED________________________________ DATE --------------------- -------------- --- - -. -r' Alterations and/or recommendations:_......v _ 5-'_-�G _. � ------ 1 ---------------- -------=----------------------------------------------- ------------------------------------- ------------------------------------------•--------------------------'-----x_9-•-------_------- ------- - ---------------------- ---------------- ----------------- ------ FINAL INSPECTION Date--------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodir California Manteca,California Tracy,California