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FOR OFFICE USE: 7 --------------------------------- a� C �- APPLICATION FOR SANITATION PERMIT Permit .... .............. --------------- -----------------------------------•--- ----------- --------------------------------------------- (Complete in Duplicate) Date Issued ______: /� tThis.Permit Expires 1 Year From Date�lssued . /...___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work_ierei dle scrib This application is made in compliance with County Ordinance No. 549. AP LoSs �1 � � JOB ADDRESS AND LOCATION- 1_Lr _V�- _------ T~ _....__` '1- --------- -- a-T"--�1or..-- / - Phone__: ' T - OwnerAddress---------------------------- ---•------ ---...• ---_-:----- - -- s Name --�-•=--�..--------. � '�=-- -------- --��=-�-C••------------o�__....__�r...._s9�� ! I q-� > .t' .. � -------- ---------------- == ----- E <s c - \ �_ ____ ___. Contractor's Name.. •-------- _ Phone..__...-. IO Installation will serve: Resilience ❑ 7partment House ❑ Commercial ❑Trailer +Court ❑ _motel [ er / / Number of living units: ."" ___ Numer of bedrooms" of ba+lis !__ . Lot sizex•J------- Water Supply: Public syst m ❑ Cvmr� nityM t. ❑ ate Dep+h to Watef Table ..______ r " (.� 'Character ofsoil#o a depth<a#3rfeet: Sand, ravel [ Sand Loam ❑ Clay Loam Q Clay ❑ Adobe[j Hardpan C] 1 Previous Application Made: {If yes date_________________ ___} Noe—* o New Construction: Yeso""r�"�FHA�/A:Yes � N TYPE.OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or c sspool permitted if public sewer is available within 200.feet.) Septic j6nk: Distance from nearest well=_.J-0----Distance from fqundation----,7a------._Ma a ;al._��_vol> —3 No. ofcompartments---------_fit- _-Size_ Liquid depthy----- ___ _ --------------- Ga acit Disposal Field: Distanc from nearest well___"____.Distance from foundation---s<D_-_.__ _Dis+ante to nearest lot line„_ Number of lines------- ��- -------Length of each l,e...... j- Width ofgtrench.------- -----------•---- , tal Type o, filter material_ _. lQ__._ -Depth of filter material____ �_____:_'__ Tostance tohneareloJtline-___________.. Seepage Pit: Distanc to nearest,welL_____________________Distance from foundation__-.____-__--____-Q x Distance from nearest welt________________ Distance from f Size: Diameter_. -----"I Depth-------------___._".________..__ ❑..-." Numbel• of pits-----------------------: Linin materia--------------- undation-------------•-�"C Hing material----------------------- �_--------- Cesspool: _:..--- --- g . Cess ool: r-q Size: Diameter Depth-----------------t-------------------------------•-Li uid Capacity------------•-•--:=-------"-gals. I Distnfrom nearest building------------------------------------------ Privy: Distane #rom nearest well ace _ , _. Distande to nearest lot line-----=-------------------------------------------------------- --•-------- - Remodeling and/or repairing (describe}----------------------------------•----------------------------------------- -•---------"- --------•. ---""--------------------------------------------- --------------- ------:_.--------•----•----"--- � . ---------- _ ------------------------------------------------ ------------------------------•---------- . _`-__.---__ - ---------- --------------------•-----------•------------- -----------•-------- ______.______________._____._.._._________...._..___..-______:_ _____________i-..."-_.___________---_._______-____________»_________--____. .________-________-.____ 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 Joan uin Local Health District. i� b �& IPWO )14o - T= Sir �3 ------- Her an r- ontractor•): - (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 ` !� DATE1-------------=--------- APPLICATION ACCEPTED BY-------- 'T711 -�--`- -----------------------=- ---------------•------------ yREVIEWED BY---------------------------------------- .. ----------------- DATE BUILDING=PERMIT,ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recornmen ations: _ = ---"---- ... ��-- ------- - .....-------•---••-----------------•---------------------------•--- -------------- --- -•--- --- -------------------------------------------------------------------------"--------- -"•-- ---------------------------------"------------------- - ----- ----------------- - - ---- ----•-------------- ---------------------•-••----=--- -•---- Date__.------ �-� -- . --- FINAL INSPEC rt 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,California Tracy,California E9-9 REVISED e•59 r.a.0 D.SM 6-60 Ai