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i FOR OFFICE USE: 'I xlY II ______________.__._.__-_-__._.______.__.____ ---------- APPLICATION- FOR SANITATION PERMIT Permit No. .....L:� J_._. 1 ------------------------------------ ( Duplicate) Complete in Dupli14 r �y Date Issued r --------------------------------------------------------- This Permit Expires 1 Year From Date Issued r�� 7,_1/ Application is hereby made to the San Joaquin Local Healfh 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 L CATION " ...._-------------------------- ---------------------- Owner's Name_ r�l._ �-. -------• ---------------- Phone---•-••------•------•--= -- • Address-------------8...1-------P "_�-I �� - ------------------ = Contractor's Name - ----------- -----------------------------------------I---------------------------------------------- Phone.......................l........... Installation will serve: Residence IV, Aparfinen ouse E] Commercial [IE]Commercial Trailer Court Motel Other it Number of living units: A-_-' _i-___ Number of bedrooms iumber of baths ___1___ Lot size ---_/ -'----------------------- -- I Water Supply: Public system ❑ Community system ❑ Private EX Depth to Water Table 5a ft. Il ; Character of soil to a depth of 3 feet: Sand ❑ Gravel P< Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Har pan ❑ Previous Application Made: (If yes,date_-------------------) No jJ ' New Construction: Yes �`No ❑ FHA/VA: Yes ❑ I1NoX s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.),' Septic Tank: Distance from nearest well----0__5 ____Dista��n//c�e f j� foundation---)_0---------Mat ialF__ .-- No. of compartments----�/----------------Size_T�(_r"_rx_t�_( Liquid depth-------�------------Capacity_. 0____-. Disposal Field: Distance from nearest well...?—$'_-__Distance from foundation ...l.y___----Distance to nearest lot li��__�®__..... Type of filter material..5. .___Depfih of filter materi ---- ttTotal Width gth.--- -f--�� = - "---_---.-- Length of each line______ __ _ ___ �-' Seepage Pit: Distance to nearest well'____________________Distance from'foundation___•_____--:.... Distance to nearest lot line_..--------------- El - _____.-_ ❑ Number of pits---------------- ----Lining material-------I-- ---------Size: Diameter-----------------------Depth---------------------!�----------- Cesspool: Distance from nearest well------------------Distance from foundation-------------------.Lining material_______-._______________p___________ ❑ Size: Diameter-------------------------------------Depth----------------------- ------------------------Liquid Capacity '_ als gals. _ ..� i+ oa.�� • fTVr�.-...� ��.�c Privy:r` Distance rom nearest well ________________________--------"_____.__._Distance from nearest building._._-_---_.____________".___l_______.._. Distance to nearestaot line. =----------•-------------------------•---------•---------------------- ------------------ Remodelingand/or repairing describe : -------------------------- --------------------------- ��_--_ •• ^- •-------------- ----"_"-- --------------------- -- p g �' �- " . -------------- -- -------------------- -----•-------------------------------•-----------------------.------------ -----------'' 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.(Siy � 9 )•-- ------ •--- -• ---- - - - � � ---- --�- .� - ._--=--�----�-----{�1�P_1"/.*2'.�--------Owner and/or Contractor By:--------------------------------•-•--•-------------------------------------------------------------------------------------------(Tit le)------------------------:-------------------------------- ------ (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). t! �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------------- ----------------------------•----------- DATE----------------------------------------------- REVIEWED BY-------"----------------------------------=-- ----- DATE------------- BUILDING - BUILDING PERMIT ISSUED---------•----------------- --- DATE ;w Alterations and/or recommendations: • ---------------------------------•---------------------- ---•-------------------------------- v, -----------------------------------------------•----------------------------••--------"---- ------------.. --------------------------------------•- 00 �l—P --------- --- ------------------------------QED f l� -------- 1�...._ ._ --------------- -------------------- ---- ..... --------- ------ -------------- • H. FINAL INSPECTION BY;...... ---- -------------4 �4� 6 Date r '� r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street II Stockton,California Lad[,California Manteca,California Tracy,California E6.9 REV,6 Eq g•g9 F.P.Ca.2M 6.5a �i