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FOR OFFICE USE: ----------- --------------------- '.APPLICATION- FOR t No. SANITATION PERMIT Permi --------------- �-o 1 :1 '. - ------------------ ---------------------- ------ -- Complete in Duplicate) 4 - - I i -----------------------I- ----- - -------- ---- --------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loc6l Health District fora permit to construct and install the work herein described. This application is made in compliance with County qrd�inance No. 549. JOB ADDRESS AND LOCATION-1 9 ---------;7 -,Wat�....W1 --------------- ------------ ------------ ---------------------------------------- ------------- -�!--------- Owner's Name------ - - ------- ---- -- ------------ -- - - - ---------------- ------ --- Phone----------------------------------- Address---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name__ ------- S----77Z------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House E] Commercial E] Trailer Court 93--Motel ❑ Other El Number of living units: Number of bedrooms Number of baths ---3-- Lot size --- --------- --------------- Water Supply: Public system 9KC-ommunity system El Private [] Depth to Water Table -49ft. I -�rdpan El Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam El Clay Loam [] Clay ❑ Adobe [If'-R Previous Application Made: (if yes idate_________________ _I No P- New Construction. Yes 14N-o E] FHA/VA: Yes ❑ No.[ -� TYPE...OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool p6irmitted if public sewer is available within 200 feet.) ------------ ---------- Se D;starice from nearest wel,140*-/-----Distance from foundafion-/6---- -------Material:71&.4161--�V/------ ----- 2. C ... ........... - ---------- No'. of compartments-, _______._______._,Size_-_ -----Liquid depth---- C a pacity.1.2-4-0,-1-64 Disposal Field: Distance from nearest well____-`-'_____._Distance from foundation—fTO-------------Distance to nearest lot line-,.5----------- Number of lines...........I------------------------Length of each line--- -0---------------Width of trench-2-19.............ie,---------- f. Type-of filter material- --------Depth of filter maferial--,/FF-eo, Total ... .. -------------- Seepage Pit: Distance to nearest well-----—-------------DistantedLw foundation--- ----------Distance to nearest lot line--d /- ------------ Number of pits.1-1---------------Lining material" j(6—t__-Size. Diameter---4t. ..... ----Depth-----1.Zj---------- I Cesspool: Distance from nearest well---------------- Distance from foundation------------------- Lining material____.__________________.________._-_ F -----------Depth-------------------------- ❑ Size: Diameter---------------------------- - -------- ---------------Liquid Capacity----------------------------gals. I. Privy: Distance from nearest wolf_____________________._- ----------�--------Distance from.nearest building_-_-_.---_--_--_------_______-_____-..__.------------------------------- ❑ i - Distance to nearest lot line-- --- ----------------r--------------------------------- r----------- ----------------------- --------------------------------------------- 0 0, I, -,4 &' . " V Remodelincl and/or repairing jdescribe)----=i .,-,------- -------- -------- -------------------------------------------------------------- --------------------------------------------I---------------------------------------------------------------------------- ---------------------------------------------------------------------7-------------------------------------------------------------=----------------=---------------------------------- -------------- ------------- -----•-------------------------------•-=--------------------------------------------•------------------------------------------------------- ------------•----------------------------------------=------- ! hereby --------------------------Ihereby certify that I have, prepared This plicqfon and that hat the work will be done in accordance with San Joaquin County f 0 an J, a 'rr ordinances, State laws, and rules and regulat* s of e San Joaquin Local Health District. E r (Signed)--------------------- -------------- -- - ------------ ------ - - ------------ - -------------------------------------------------------------------------.(Owner and/or Contractor) �o ---ia By:------------------------------------------------------- ---------------- -------------------------------------------------(Tif le)---------------------- ------- ------------ - - ------------- ,c v (Plot plan, showing size of lot, location of system in relafi, n to wells, buildings, etc., can'be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------------------------------------ DATE- -- ----------------- REVIEWED BY------------- - I DATE - - --- ----------------------------------------- -. . .. ------- - BUILDING PERMIT ISSUED )...... - - - -- -----------------------7 ---- ----------------- --------------- DAT --------------------- ------------------------------------ Alterations and/or recommendations:__._ ......9:77�7=4 -?- -------------------j------------ ---------- --------------;t- Ze-------4- 6------------------------------------------------- - ---------- - Z/� - �------�!�---ejw,�,-4- ----e--W.X---------------- ---------------------------------------I- ----------- -------------------- - - ----------- ------------------------------------------------------- -- ----------------------------------------------------------------- ---------------------------------------------.------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- FINALINSPECTION BY:----.-- -- Date-------------- -i--------------- ------ ------------- Da ------..-__/------------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nox*lton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RgVisEO B-59 3m 3-63 F.P.Co.