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FOR OFF USES y APPLICATION FOR SANITATION PERMIT Permit No. .........3.3 ----------- ------- -------------------- -------- (Complete in Duplicate) !-,. / _________________________________________________________ This Permit Expires 1 Year From Date Issued Date.�ssued _ !___- & 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_ ��1',�� r�--•.---._- --------------------------------------------------------------- -------- --------------------------- Owner's Name---------------��-7I1wax.-- �1, �t - --------------•---------------.__ Phone l�1 ..7-C6�- Address----------------------------- - ----------- w_G ------------------ --•--------------••----------•-------- ------••--••----•-- Contractor's Name- 1.... A_ -_' ��)J------ �. e Ff t -----------•--•----• Phone-19!b---- � Installation will serve: Residence D Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: Number of bedrooms . Number of baths __ � .. _ v_-__________._ � �__. Lot size _Zo! 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 E� Hardpan ❑ Previous Application Made: (If yes,date--------------------_I No ❑ New Construction: Yes ❑ No;e�, FHA/VA: Yes ❑ No ❑ T; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Distance from nearest well_________________Distance from foundation--------------------Material___________________-_______________.____________. No. of compartments------------------ -------Size_------------••-------••------Liquid depth--- ------------------Capacity....------------------- po 6ield: Distance from nearest well._KG$p__-Distance from foundation.10__ "1Distance to nearest lot line.....+ ---- Number of lines.--------t-----------------_-------Length of each line________ Width of trench._____�3Z'-------------- .1-A-d Type of filter material-_ _ - Depth of filter material___ length----------/--- ---*,f_______________ Seeps a Pit: Distance to nearest well-_N.k_tLe-------Distancenndation__/__0_'____.Distance to nearest lot line----- r__ Number of pits______I______________Lining materi ._ ___Size: Diameter---..341'-_._..-Depth----------rte-.Ir'__.-_._..\ Cesspool: Distance from nearest well-________________Distantndation___.______._______..Lining material__.____-________---._-----.-_.__..___ ❑ Size: Diameter--------------------------------------Depth---•------------------------------------------------Liquid Capacity------•------_---------•-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_._____-___-______-_-_--_____________-- ❑ : Distance to nearest lot line------------------------------------------------------------------------------------••---------------•----•-----------•----------------------- Remodeling and/or repairing (describe):--- --- ------ ----------- +----------------•-•--•----•--•----- ------------•------- ----•• -------------------- --------------------------------------•-------------- -. ----- --------------•---------------------------------------•--------------------------•- -•--------•-•------------------------------•------------------ ------------------- -•------------. ----•------------- - ---------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta Iaws, and rules and regulations of the San Joaquin Local Health District. (Signed) �-=� , / k c,----- Contractor) By------= ---------------=-------•-•----•----............... •C '... ----------------(Title)---------------------------------------- ----------------- (Plot plan, showing size of lot, location of system in relatio o wells, buildi�etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY DATE Z tea'.f 6;r------------------------- REVIEWEDBY--------------*------------------------ -------------- --------------------------------------------------------------------- DATE---------------------I-------------------------------------- BUILDING PERMIT ISSUED---------------------------------- ------ ----------------------------------------------------------- DATE--------------------------------•--------------------------- A _i �nd/�yecomrnend n�, 721- - �/ _ r ------- ' - --------••-------•-••--------•----------••-------- --- ---------- ---------------------------- ---------------------------------------------------- ---------------------------------------------------- -------- ----------------------------------------------- ---_....... ----------------------------------------------------------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----( .__--- -----�1 --- ----------------------- Date..... --------------------- --------------------------- ------------------SAN JOAQUIN LOCAL HEALTH DISTRICT" 130 South American Street 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6.9 REVISED e•S9 F.P.CO.2M 6.60