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FOR OFFICE USE- f� --- -----------•-------------------------y-o APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- - (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 LOCA ION--- �'_- &A-� (��.--.��---------------------------- --•------•------•----- Owner's Name----- ` r�t�f .___/I,rd~ --------------------------------------------- Phone------------------------------------ Address---- / ----�:-----------------------------------------------------------------------------------------•-------------------•-----...._..---------------- iContractor's Name-------- /� ,/-v�. _ �� -----------•-------- ---------------------------------- •--•--------------••---- Phone----------------------------------- Instaliation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-.- Number of bedrooms-_ Number of baths __/__ Lot size Al-4-9 -------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e--1: ardpan ❑ r Previous Application Made: (if yes,date_------------------J No E' New Construction: Yes 2`No ❑ FHA/VA: Yes [B 'l0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank: Distance from nearest well _______________Distance foundation._Z0---_--_-Mat'erial!__ ---��_-'._.11i.r ----------- No. /� �} No. of compartments.--..-� Size_6� --��yLiquid depth----- -___.---._-Capacity... ---- Disposal Field: Distance from nearest well__'-.--.Distance from foundation---_• __ /7/ ��_____.__Distanca +o nearest lot line__: ___ i Number of:lines__:_____---:--- Length of each line___/ ____!_ � Width of trench_. _______ _________________ oe Type of filter material ___ _` ___ -4—Depth of filter material_./--------------Total length-----A�5'V---------------- ----- le' —11 Seepage Pit: Distance to nearest well------ --____Distance f om foundation----1 __....---.Distance to nearest lot line_'__-__ -__.-_ I Number of its----. --_-Linin material, -.Size: Diameter. .".._. P g Depth--..V'� Cesspool: Distance from nearest well--------___._.._Distance from foundation------------------- Lining material ___-..-_---_---_-._---___--_-_-._-. 3 Size: Diameter--------------------------------------De th----------------------•-----------------•-----------Liquid Capacity --- gals. Privy- Distance from nearest well-_.----___---_--------------------------------Distance from nearest building---------------------------------._____-. ElDistance to nearest lot line-------------- '-------- --- -----------------•----------------------•------ ---------•----- -------------------------•-------------------- Remodeling and/or repairing (describe)---------------------. - - ?s%.--'-_-----•-•-•--------------------•-_-•---- ----------€-------•------------------------------ ----r------------------------------ - --•---•-------------•-----------------------------------•------•----_._------------------........-...---------------•----------•------------------•------------------ 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. ned ----- ------------- (Ow�r_Contractor1 Si( )------------------ 9 --- - - ----- ------------------------- By: (Plot plan, showing size of lot, location of systeml relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USAF ONLY APPLICATION ACCEPTED BY---- -_�._.�_-._�. - ---------------------=-------- DATE...-- -��7----------------------- ----•---- REVIEWEDBY ------------------------------------------------------ DATE------------------•-------------------- BUILDINGPERMIT ISSUED---------------------------------------------------- „ -- --------------- DATE- ------------ --- --------- Za c. ` �Alterations and/,or recommendations: - .............r........ ............... ..-..- ........ ------------------------------------------------------------.-.-.-.-..--.-.------. ------------------------------------ ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------- - -------=---------------- ----•------------------------------------------------ ------------------------------------------------------ r r' �- FINAL INSPECTION B Date------- ��----- ' SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Slreat 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6-9 acV�aEC B•59 r.r.CC.2M 6.6C r