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FOR OFFICE USE: ----------------------------------------------------•---- ._. ______________:__..___.__.---..___._._______---___._._. APPLICATION FOR SANITATION PERMIT Permit No. ..��[�.a�r� ---------------------------------------------••---------- +*w (Complete in Duplicate) ------------------------- ---------------------- rtThis Permit Expires 1 Year From Date Issued Date Issued ....:.. �� Application is hereby made to the Sen 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. }POAr � a n . JOB ADDRESS AND LO ATION::.. -- --------- M _-------- .D N ,�_...._.. __......_.:. : 1 I Owner's Name ------------ rq- .- Q1 `= .1 [1L ---------------------- -------------- Phone-------------------------------- Address..... p- MT------... ] �?. .....At --------1 ---.--------_---...............4%. S Contractor's Name------- ---------------------------------------------- ..--------- ---------------••---•---------------- Phone--------------...... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Nailer Court ❑ Motel Other ❑ j?FS15Rj Number of living units: _ Number of bedrooms -�__ Number of baths . '.,Lot size ----i�C ; �_............. Water Supply: Public system ❑ Community system ❑ Private Depth too �`aA!r Table 13 ft. Character of soil to a depth of 3 feet: Sand , .,/Gravel Sand Loam cla�Lo- Clay Adobe Hardpan P I� ❑ Y ❑f` Y Ca Y❑ ❑ 0 Previous Application Made:`(If yes,date________________ __) No. Me New Construction4s_ No_D,�EHA/VAq Yes �No _ TYPE OF INSTALLATION AND SPECIFICATIONS: r Septic (ank• P • Distance from nearest well__ _,?_0-_ Distance rornsfounda�00 feet.) No se tic tank or cesspool permitted if public sewer is available within __ �# 6 �- --- � -�,- r tion----�0......... Ma�ar •--•- [ No, of compartments____.._ ## s F- f Disposal Field: "Dis#ante from nearest well �...._d stance�fro�m,�f� � Liquid depth_• _/ ��________Capacity.__ Q.O_ ; �. li 'foundation____/Q...._._.Distance to nearest lot line----S....... W t- A * 'k- � r t� YP -----------------------Ifengtli of-each line----_/00-------------.Width of trench-------36_--_.-.._-•---------- Number of-lines____________ Le T e of Iter material._._ _ Q pth of 'filter material------'2.0 `____Total length......../,Qio...�________________ Seepage Pit: Distance to nearest well-___.____________-4Dis 5 ce from foundation....................Distance to nearest lot line__................ ' ❑s Number of%pit��s-----=------- LiningAmaterial-----------------------Size: Diameter-----------------------.Depth-----------...............•...... . L ' Cesspool: Distance from nearest well------.._._Aistance from foundation--------------------Lining material----------:..... .---------------- ❑ Size: Diameter------------ _ ....Depth.---------------------------------------------------Liquid Capacity-------..... --gals. Privy: Distance from Weare`swell___: ----------------------------------------Distance from nearestrbuilding------------------------------- r rr r ❑ Distance to nearest lotdine--------- ------------------•--------- -------------- +" 4=" ✓ . Remodelin and/or repairing descCr, :_ :-� ,., 9 P 9 ----------........ = -----------••---.__-" _i ' : ------•----------•--•------•--- -- ------------------------ -..------ - -- j ; "a+lF fig......---------------- ----------------------------------..................................................--•------------- 9 N hereby certify that I have preared +his application'and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a '8 re mations of the San Joaquin Local Health District. Si -- - �-T_E------------ -•--=-----------------------'--_---_--=------_- -...--=--------- ::---__--• --_--=:-...__....._._ ._ - (Owner-and/or-Contractor]._-:.- ...............................................---•----------------------------------- ----------- (Plot ,len, showing size. of lot, location of system in relation to wefts;b�lildings, etc., can be placed on reverse side]. : FOR DEPARTLlvIENT USE ONLY kPPLI,CATION ACCEPTED BY--- � -• •- ----- -I `� ------------------ DATE..---3.`"_.�lr�.l 'REVIEWED BY--- ------------------------ ..---------------------------------------- .... --- DATE_-_---•-•------•--••-------- BUILDING PERMIT ISSUED...... ----------------------------•---------------- �--------- . _--• -------------- DATE---•----•--------------•- ---- Aferetions and/or recommendatons------------------------------------------ .. . -..- - -•--------------------------------•---------------------•------------ .......... •-•------------------------- --••------ ------------------------------------ . `"`'4 ''`' "" ----------------------------------------------------- FINAL INSPEG__.. .:ABY:. Date------- - `.b`.J� SAN JOAQUIN LOCAL HEALTH DISTRICT 130$outh Alniricon Street 300 West Oak Street 124 Sycamore Street 285 West 91113!sit Stockton,California Lodi,California Manteca,California Trac California ES 9 ARYISEo S 59 eMM.15-61 At.AS . Y