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FOR OFFICE USE: `,/sr _________________._..__.-___-._____.___--..___-.---___._ APPLICATION FOR SANITATION PERMIT Permit No. 2.1.!K9 v-- ----------------------------- - ---------.-.-_ ------ (Complete in Duplicate) - ------ This Permit Ex ires'1 Y ar From Date Issued Date'Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wofk b6tein described. This application is made in compliance with County Ordinance No. 549. / �j 1 JOB ADDRESS AND LOCATION--�_�`. `----•--eC J1,--_-_ J__ f Lf A / IN ��-� e �r. i Owner's Name _1 alIV -----�. Vii--------- --•--- Q ---- -``ir Phone Address _ ------------------ --------------------------------------------------•------------------------------------ Contractor's Name-----�Q__. Ss7, ------------•----------•--------------------------- ---------------•---••----------------------- Phone----------------------------------- Installation --•----•------•--•-----•--------installation will serve: ,Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms ____:�._-Number of baths __IC----- Lot sized_-1(-_/1_];S--- ----------- Wafer Supply: Public'system ®Community system ❑ Private ❑ Depth to Water Table _x-.19.___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq---Kardpan ❑ Previous Application Made: (If yes,date........... ........) No New Construction: Yes [3--No ❑ FHA/VA: Yes ❑ No ❑— Y 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_f,C�_____________Material____I-�- -a�__--. No. of compartments----2.-----------------Size----> x �__x__ --Liquid depth....4_1------------Capacity___rO,0_.2�_<_� Disposal Field: ..^Distance from nearest well_ .._._._-Distance from foundation__/ r---------Distance to nearest lot line__15�.... [r— Number of lines-----------1-----------------------Length of each line-------9LJ-e------'_----Width of trench----'------------------------------- Type of filter mateal__" GG�[______--Depth of filter material___,($- _ _ ri --------Total ..length-------------9-42-----•----------------- Seepage Pit: Distance to nearest well____ ________=_Distance from foundation_../.1?.----------.Distance to nearest lot line--:4~......... �,®! Number of pits-- --------------Lining mate Size;---Size: Qiameter_____ -----......Depth--- __.------ ----------- Cesspool: Distance from nearest well-__`______________Distance from foundation..___, y_-_._---__.Lining material------------------------------------- _! El Size: Diameter1----------------------------------De th------------------ --------- � ' Liquid Ca acity-------------- gals Privy: Distance from nearestwell-_____________________ _---_______._____-_-_____Distance from nearest building--------------------------.__..____..____- EDistance to nee est lot line------------------------------------------------------------------------------------------------------------------------------ : I ( - Remodeling and/or repairing (describe):------- -------------------. ------------------------------------------------•----------------------------------------------- ---•----------------------------------------------------------- ---------------- } OD ---------------------------------------------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 fhe San Joaquin L al Health District. f ` ,� (Signed r._ �"P`a ------- ------------------------- ---------------------------------------(�r Contractor) .-_ _ By:--------------------- -------------------------` -- ----- - ----------------------•-----------------•---------------------(Titley------------------------------------- -------- -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). 1 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------- DATE---�__ REVIEWEDBY------------------------------------------ -----------------=-------------------------------------------------------------- DATE------- BUILDING PERMIT ISSUED--------------------- -- DATE----------- ------------ - - - ------ ----- ---------------- Alterations and/or recommendations:--_ �C_'_91 --: �-,L - •-------- ---------- ' I------------------------ =------------------------------- ------------ -----------------------------------------------------------------------------------------------------------=---------- FINAL INSPECTION BY:------------ ------------- ------------------ Date---- -- - _I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak S+reel 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEO 9-59 3M 3-'r.3 C.p.CO. 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