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FOR OFFICE USE: --- ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _--IJI ------------- ---- -------------------------------------- (Complete in Duplicate),___._ _ -.-_- This Permit Expires 1 Year From Date IssuedDate Issued .__4 -1! 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 Coznty rdinance No. 549. f�j��( j �j .,7- 7_10— � �10.. G w g��/- k e y' �] JOB ADDRESS AND OC TION...... i��__r ! x'1'`'3`�•.• Owner's Name---- ------ ---- --/-J D '�rrrS!L ? .._.]: L_4? Phone { ....... Address-----,-----_----- - �d7� �t rn � � •,�*�"�-0_ - --- 3 7 --�`� Phone f.' .. __ -- Contractor s Name.. `y4/1,:C'P.l � :.:._-:A�..-------- ------------•---------•---------------•--•-----------•---• -- ----------------•--•-----_ •---• Installation will serve: Residence ❑ Apartment 4 House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other'WD-4,11 e,- l Number of living units:--------- Number of'.bedrooms -------- Number of baths -------- Lot size _____________1_ a_...4rt-. ................ Water Supply: Public systam 0 Comiunity system El system Depth to Water Table ------_ ft. Character of soil to a...dep�fh'Io'3 feet: Sand Gravel E]—Sandy Loam Clay Loam Z Clay ❑ Adobe❑ Hardpan ❑ Previous Application'tMyade �: (If yes,date :.---_-'--_ No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes E] No ❑ -- TYPE OF INSTALLATION AND SPECIFICATlONS:� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:-, Distance from nearest well_S �' _ Distance from foVndation___fa---------Material--- of compartmentSsquid de h �-No a�; Y --- iDisposal f a Field: Distance from neareIt wellz o_�_Distance from foundation____z�. - _.___.Distance to nearest lot.line Number of lines-------)/_00___ ___-- Length of each line------f _p_-...---..Width of trench------------------------------------ Type of filter material___` -------Depth of filter material__-_��____-.- Total length------ -___________________ Seepage Pit: Distance to nearest:well__________ _________Distance from - _r,to nearest lot line_______-___-__-- ❑ Number of pits------------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well____I___________Distance from foundation------------------..Lining material--------------------.__.__._-_-._____- ❑ Size: Diameter------------------------------------Depth---_----------------- -----------------------------Liquid Capacity----------------------------gals. Priv Dista `from-nearest well____________________-_ _Distance from nearest building Privy: ---- - -------- ---------------------------- --- -- -- �❑ Distance to nearest lot`line---�-----------------�-••-------------------------------------------------•-•-- `{Remodeling and/or repairing (describe):------------- -------------------- --_--------------•-----•----------------------------•-•----------------------------------------__----------------- = -----------------------------i--•------ -------------------- ----••-----------------------•---------------------------------------------------------------------------------- 1 ------- - ----------------------•---------------------------- �. 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. '(Signed)--- aCc ------ -------------------------- -----------------------------------------------------Owner and/or Contractor) t BY#------------------ = {Title) (Plat plant showing,size-of'lot ocati sof s m i relati o wells, buildings, etc., can be placed on reverse side). dt FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY If ----AJ- ------------- ---------------------------------------- DATE------ H ---------------------------- REVIEWEDBY--------•---------------------------------- -----------------------`-•-------------------------- ...... ------------ DATE------------------------------ -- BUILDINGPERMIT ISSUED---------------------------------------- -------- ---------------------------'----------------------- DATE---------------------------------------------------- Alterati ns and/or recommendations recommendations: - z4 �-�- •_ ------ = ------- - --- -------------------------------------- ----------------------------------- -------------------------- --------------------- ----------------------------------------------------------------------------------------- ---------------- r •--•-•-------------------------------------------------------------------- -------------------------------------------•------- -•-------------------------------.------------------------------------------------------------- , -------------------- ------ -------- ------- ------------ ------------------- -------------------------------------------------------------------•--------------------------------------------------------------------------- FINAL INSPECTION"BY:..."-'_;rla_...._.i,� ------------------ ��c��-+----------- - - Date------------�� -/- f�'• - -----------------------•--• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod],California Manteca,California Tracy,California E5.9 REVIBEO 0-99 F.P.EO.3M 6.60 1