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FOR-OFFICE USE ................................... -•-••-•-•--••••- ......- APPLICATION FOR SANITATION PERMIT Permit No. .../ i �4 ..................................................... (Complete at Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 47�_ _�Y 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. 544. A ivTsca . % O ADDRESS AND ATION_.DlSj.._.. r�I. - -- 4' ?l�P__.../'7'ttv-;5g::....1L!! ...Q .__�?�?:.411Q ... �1M.._.11N10(� Owner's Name C .-..--. 1..r,�_.'..- ---------------------- - - ......... Phone....... - Address.............RX, .......... > 1 4 Contractor's Name-........D-.WVN-IF.k� ......... -_' ..................•......-.......----------------- --•----.....�............ Phone.._......-...................... Installation wM serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I..... Nu I ber of bedrooms.?-- Numb;4o baths/:2:.Lot sae -_jj9_3...__�_-._- Pd_.:•............. Water Supply: Public system ❑ Community sy m ❑ Private epth Water Table ..iP_ ft. Character of sol to a depth of 3 feet!"Sand UTGravel [3S!nOy Loom❑ Clay Loam ❑ y❑ Adobe❑ Hardpan❑ Previous Application Made: (lfyes,date------ ------------) No Now Construction: Yes No ❑ FHA/VA:Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T k: Distance from nearest well...S?....Distance frqln foundation...119.........Motorial.-r, EGI�ST• No. of compartments. �� x,- !t! .OQ _._...._.Size_. ._Liquid depth . CepaCity.. Disposal ld: Distance from nearest well_..4 ....Distance from foundation....J.49 _..Distance to nearest lot line. .. Number of lines...........#Z ... ..............Length of each line----.-_��-&.qWidth of trench..._.. .��?................_ Type of filter material__.. QC ,_Depth of filter material...... _r --------Total length......... -.----_------------- . Seepage Pit: Distance to nearest well......................Distance from foundation-----------------Distance to nearest lot line........... ❑ Number of pits..-...................Lining material...................... Size: Diameter.......................Depth................................ Cesspool: Distance from nearest well_..._..±._....._Distance from foundation....................Lining material..................................... m ❑ Size: Diameter......................._.............Depth---_--_---------------------_---•-•------...Liquid Capacity...._._...... .... .._...gels. � Privy: Distance from nearest well.... ...................................Distance from nearest building----------- - _ Distance to nearest lot line— .....................................................•.............._.....------.._.._ -•-•••......--- Remodeling and/or repairing (describe):.... 1 I ...........................................---...-----....------ - _ - •--•-----------•---•---------••----------------...--------•-------...._......--------•---................... . f .....................................................-•--•--------------•-:,-•---•-•.-•- --........---••---------------•--- •-••................_................................................................. .............................................................--......._.._...----------- _._.....---,..-........-..-...-.-_...-...._..---------------------------------------••••---------------- I herebycertify that I have prepared this application and that the wtsrk willl be done in accordance with San Joaquin County ordinances, to laws, end 9% and regulations of.the.San,Jon quip.Local Health District. Signed .. .. ...._.__'r<%( ) ....................................................................•---...------•............... .........----••... .....-(Owner and/or Contractor) (Plot plc .showing sire of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side). ��p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.......--•�--+-`RcV.-..........................—.....--........................... DATE--•-----> - REVIEWEDBY - ---------------------------------------------•-------------------------.-...---.-....----.._...... DATE..................................-..................... BUILDINGPERMIT ISSUED------------------------------------------------------------....................................... Di4TE................................................ Alterations and/or recommendations:.....................-•-••--••-•-...----•...•-----•............•---•••--------•--••--------••-----....•---•...--•-•---•---.........- •...................••----•--•------•-...........__•-----_-...---.........-.......................................................................... ......••••••••........••--••--••••......--•-••-----•-••--•--____ ....---............................—........_._.............................-.............. .. .. ................ . . .. . . .......................................................................... •-------...-•--- -•-•-••..----------------FINAL INSPECTION 13Y--------1--_% -..,•- ----•--•----...._. ............................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycanters Street 203 West 91h Sir" Stockton,California Ledl,California Manteca,California Tracy,C911fomie E8 9 1tI1VI8ED 6-89 =Lt D-A/AILAO T s