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ruK Urrll.t UJt: -- ----- -- ------------ i..___-- _._._- ---_---_----_---.----__---. APOOCATION FOR SANITATION PERN./ Permit No. ?l . -------- -- ------------ ------------ (Complete in D'3plicate) i .---_------------- _-.-__..______-__-. _- This Permit Expires 1 Year From Date Issued Date Issued L Application is hereby made to the San Joaquin Local Health District fo permit to cczLs ruct In a work herein described. This application is made in omplianc) with County Ordinance No. 54 . I%7� 3ja4 Q» SS AND C 4 JOB ADDREATION AGKT N A? ..lt+u.-.. - --'S- - - Owner's Name------------- ..... '---------R---------------------------------------- Phone.------.------------•------------- Address......- 13 TE.=j_- � �p. - -' ` 1.�Q -�-------------- - - ... 1. Contractor's Name_AM.H0Afx...�...5-Q.1[S'. ----------- ................ Phone...........-................. Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ TrailarsGotwt eMofel ❑ Other ❑ Number of living units: ---(... Number of bedrooms LNum6er of baths _j-_. Lot size --------------_----- L Water Supply: Public system ❑ Community system ❑ Private U],o-ffe�pth to Water Table I5-7—ft. Character of soil to a depth of 3 feet: Sand �avel ❑ Sandy Loam ❑ ' Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ it. Previous Application Made: (If yes,date---------- ........) No New Construction: Yes ( Flo ❑ FHA/VA: Yes ❑ No gra TYPE OF INSTALLATION AND SP.ECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200-feet.) L �.....--_.Material---COA—f A�T ........ Septic Tank: Distance from nearest well ___'Distance from foundation-_- No. of compartments._-__.....___._Size_ u.F-_x_�____,_..Liquid depth..... --------Capacity... _... Disposal F- Id: Distance from nearest well. --_Distance from foundation_.-.. --_� Distance to nearest lot line__---5_...... Number of lines----- ...._.`-_______._.___._.Length of each line__--_-� --------Width of trench.........'� --------.____-._ s Type of filter material----RO-cK:-.Depth of filter material------417--- ----Total length--------yQQ.--------____........... L Seepage Pit: Distance to nearest well__-----------------Distance from foundation....................Distance to nearest lot line----------------- 0 ❑ <Number of pits------------------_.-Lining material--------- -----------.Size: Diameter........-------------.Depth--------------------............ d Cesspool: Distance from nearest well -_____-_._.---Distance from foundation----------__.----.Lining material----..----------..................... ❑ Size: Diameter---------------_ ------------------De th---_---------------_------------------------Liquid Capacity gals. Privy: Distance from nearest well-----------------------------------------------Distance from nearest building----- ----------------............ ...... ❑ Distance to nearest lot line- ..---------- ----------------------- --------------- ...---------------- ----------------..----_------------- f Remodeling and/or repairing )describe):------------------------ ---------------'--------_----,u---....--------- ------- ` ---------------------------------------------------- ---------'---------------------------------------------------------------------------------- ( ----------------------------------------------- ---------- ----------------------------- -------------.--A----------------- 6- -------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------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 Joaquin Local Health District. `J (Signed)------------ z ----- `' _ .: ---------------------------------------------- -------- (Owner and/or Contractor) -------------'--------------------------------------------------..(Title)-------------------------------------- ---------- ----- p (Plot plan, showing size of lot, to of system in relation to wells, buildings, etc., can be placed on reverse side). see FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- a ' ------------------------------ DATE.. ---�L 66------------ REVIEWEDBY--`----------------------------------------------------------------------------- --- ----------------- ----- DATE------------------- --------------- ------------ BUILDINGPERMIT ISSUED.-----------------------------------_........ --------------------------------------- ---- DATE-----------------------------------------------.._------ Alterationsand/or recommendations:.------------ ---------------------------- ----------------------------------------------------------------------------------------------------- less ----- ------------------------------------ - ` -...----------- ----------- ...- - ---- - ---- -- ------------ ----- - ...- -- FINAL INSPECTI BY:- - ------ - - Date_._------------- ------- -------------- I.e SAN JOAQUIN LOCAL HEALTH DISTRICT PLATE 11, Page 2 of 16 1601 E.Hotelier,Ave. 300 West Oak Street 124 Sycamore Street / 205 West 9th Street Stockton,California Lodi,California Manteca, California Ii/ Tracy,California r.r.co.