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FOR OFFICE E: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....................... --------------------------------------------------------- (Complete in Duplicate) a $f / f, -------------_---_------_------------------':_.._" � '� This Permit Expires 1 Year FroDate Issued Date Issued ......____1-f--�. -- .l ' Application is hereby made to the San Joaquin Local Health District•for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND °T ------------ Owner's Name A.1�',� . . _ +--_--------------`---•------- - -----•-- ------- -- Phone-------------------------•-•-------- Address-_4V. ..............--------------••------•--------------- --------------------------------------------•-•------ •-----------------••-----•--.......-------- Contractor s Name----4-1-'V--W ~--�t-----•-------------•---------•-----------------------------------'-------- Y'g .�....� -- Phon = -------- t Installation will serve: Residence IX Apartment House ❑ Commercial ❑ Trailer Curt ❑ Motel ❑ Other ❑ Number of living units: -1---- Number of bedrooms .-r.I_. Number of'baths .--/--- Lot size ------------------------------------------------------------ Water Supply: Public system Community system❑ Private`❑ !Depth to Water Table -------- ft. •, Character of soil to a depth of 3 feet: Sand.'❑ Gravel ❑ Sandy Loam Q Clay-Loam,-[] Clay ❑ Adobe® Hardpan IF Previous Application Made: {If yes,date--------------------I No ❑ New Construction. Yes g`ls No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if,public sewer-is available within 200 feet.) x Septic Tank: Distance from nearest well-------- --------Distance from foundation---/?....--..__ �] Mate - '-- Liquid epth----- _ pr- ------_-No. of compartments_._-___ ---------Size--, --- eCapacity_ l--CA C- Disposal --- - Field: Distance from nearest well-----------------Distance,from foundation"--_1_.6....-----Distance to nearest lot line.---)r-O.---. Number oflines------------0.�--------------Length of each line_/C�-+.-$'�k'_5- 1�1Nidth of trench......�`--,-------.---------.--- T�ype of filter material-----40Bt-If.--Depth of filter material----/_jr.........'-Total length- --------------- L Seepage Pit: Distance to nearest well__-------------------Distance from foundation-------.-----------.Distance to nearest lot line................. 4\ ❑ Number of pits----------------------Lining material-----------`_--------Size:Diameter------------------------Depth--------------------------------- &J Cesspool. Distance from nearest well-----------------Distance from foundation-------------------.Lining material--.------------------.-------.-------. ❑ J Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------...gals. Privy: Distance from nearest welL------------------------------------------------ __Distance from nearest building__ fDistance to nearest lot line-----------------------------------------------•------------•-----•---•--------------------------•----------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------11i- ------------------ ---------...---------•---------••-------------•--- -----------...--•----•--------------•--------------- L ''i: t -----------------------•-•---. --------•---•--------------------------------•--------•-------------------------------------------------------------------------------- -------------------------.-.------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------- r I her-eby 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)--�r,F "'tJ'°�'a's -�!� �-- =------------------------------------------------------------------- ---------------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------=------------ --------------------------------------(Title)---------------------------------------- --- - - ------ (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 �9 APPLICATION ACCEPTED BY----- F ---------------------------------------- DATE------v .= REVIEWEDBY------------------------- ----- ----------------- DATE----------••--•--------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------=--------------------------- --..-.--........-. DATE---------------------------------------------- ......... Alterations and/or recommendations:-------------- ---------------------------------------•--------------------------------•-----.-..----------- ----------_--- -•---------------------•-----------------------------------------------------------------------------___----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- FINAL INSPECTION 'BY:..--ej1 'G ----------- Date.---- -1�- r�. -- .... ,--------------------------- Ny I 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,Callfornia Tracy,California [9-9 R[V19ED 9.59 F.P.CD.TM 6.6a