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` ------�-6 F R OFF CE SE: .. -- APPLICATION FOR SANITATION PERMIT Permit No. .-.-1.............I {Complete in Duplicate) / ---------------------------------------------------- Date Issued ..��1-/�- ----------------------------------------------------': - This Permit Expires 1 Year From Date Issued ` 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 l��l� .aY/' -----••--•----•--••-------•------------------------------------------•------- Owner's Name------ •`/-----•------•-------•----•--•-----•-----------------F--- ---------•----------- ----------------_ -- Phone----•------------------------------- Address-. ...... -----•---•-•--------------•---Address.............. Contractor's Name. .---r...--•-•------ 1._± 1 .rl-.. ---- •-----•--- ---- ------------------------ Phone------------------------- Installation will serve: Residence El -'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitsil __-- Number of bedrooms .3__. Number of baths _L Lot size ---f06 ............................ ..... ----------- Water Supply: Public,system F] Community system ❑ Private ❑ Depth to Water Table� _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'❑ Ciay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (if yes,date--------------------) No [B" New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No 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-----------------Distance from foundation--------------------Material--------------..-----------_-------.---.-.--_---. ❑ No. of compartments--------------------------Size----------------------' =-.Liquid depth.... ---------------Capacity----------------------- Disposal.Field: Distance from nearest _'Distance from foundation- ----------------- Distance to nearest lot line...5_-4 r.!:� Number of lines------t------- Length of each line___--3P---- ------------Width of trench---2-y__---_-._-------__---_-- yp filter material-_ _ Depth of filter material---�6 f__------.-Total length----_-..3o..�....................... Seepage Pit: Distance to neares#`well_- IJistancfrom foundation---y9----------Distance to nearest lot line__6 Number of pits-_---r--I ----- g fe - P �- �------------'.'-t— _Linin material__.--- ---.-Size: Diameter 3--.----_-..De th______ _j------------------ .i. Distance from nearest well_-_--`---_------Distance from foundation...............-----Lining material----------------------------------- e - ❑ -Size: Dia'meter---;--- --------------------- -----Depth ---------------------------------------------------.-Liquid Capacity----•--_--••---------_-..gals. y❑:' from ne rest well------------- --------------Distance- from nearest building_-__---..-.-.__.___..__._..-.__.-_.------. Distance -'� Priv Distance to ne ret lot line--, - ------- ------�------ Remodeling and or repaving "escibe] I ------------ - a. s _ -- -. ------------------------------------ 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 ul and regulations of the San Joaquin.Local ,,alth District. I • (Signed) "--- -------- --------- ---------------------- [ Owner and or Contractor B Title (Plot plan, showing size of lots, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY---------C___I�'.1 - DATE REVIEWEDBY-----------------------=11--------------------- -- ----------------------------------------------------------------------.--- DATE------------------------------------------------------------ BUILDING re SUED-- ---------- --------=----------------------------------------------------------------------- DATE--------------------------- Alterations and/or , ' da+ions:--[-'-fa--`--- -1 - -----------k--c�-t--��-� -E.�-+-�-- -~-�'--- �------•- �' ----- , GIz ------- - ------- — --- --- - -- - - -------- Y. s ------ -- I-- s i p -'- - '---f -- .:Y ' Y '--.e... -,.E--f-fir --..--•- -- .------•- -�----,.. -_- y' i1�,t � .R L f FINALINSPECTION BY:--P-------------------•-------------------------------------- f Date-------------------------------------- ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ,1 130 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 6.59 P.P.CC,ZM 6.60 �E