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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..r .,C...... - ------ - - ----- ------ ---------------------------- (Complete in Duplicate) .- This Permit Expires 'T Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w erein described� This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAjION�2,/� ' 0---- -____- - -- / flc_ fSlf__•__ •_- -- Owner's Name------ "1 ------ -- - -- ---- ------------------ Phone------- y, Q Address----- --- ------------i- P� Contractor's Name--------------- 1 moi' O' --------------------- ------ ----- Phone--------------------------------- Installation will serve: Residence ZKApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z--- Number of bedrooms A- Number of baths _?�--- Lot size _-____________________ Water Supply: Public system ❑ Community system ❑ Private t Depth to Water Table 4691ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Wp,"`51ay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (!f yes,date--------- ----------) No 5g,"New Construction: Yes gp,-no ❑ FHA/VA: Yes K4--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest w ll_ff� Dista ce from f ndation__la ----------Mater a.�1 _ -------- ®� No. of compartments- - ---------------- Size 9°', X9_Liquid dep.th__ y�".-._______ __CapacitytV----_-_.--- Disposal Field: Distance from nearest well..Pt .-- --Distance from foundation_ o __ --_.Distance to nearest lot line-4!6-----___-- Number of � lines___._.____. . ___ ngth of each line_ le .-�__ Width of #renchrr��l___.------------------------- - - ----------- --- Type of filter material ` ' ep#h of filter material__.---J_Total length--------- -----------------r_.---- Seepage Pit: Distance to nearest well ----_Distance fr fo dation---t"00---__ Distance to nearest lot linne_.t� Number of its---.- ,_ _Linin material._ f/w� � _ p { -.------- - g © -- -.--Size: Diameter_��l.Tl��,�eptn_-/r _.-- _ Cesspool: Distance from nearest well-----------------Distance from foundation___- Lining material---.--_------___-_.-__-_----._-----. Size: Diameter-------------------------------------..Deth-----------------------------------------------------Liuid Capacity gals. Privy: Distance from nearest well____________________________ __________________Distance from nearest building_._________-_-- _________y____..._.- ❑ Distance to nearest lot line------ ------------------ ------------- ----- ---------------------------------------- Remodeling and/or repairing (describe) �( �T ------`--------------------------------------------- n -------------------------------------------------------------------- ---------- ------------------------------------------------------- ---------------•--------------------------------------------------------------------------------------------------- •--------------------------------- --- ------------------------ -----------------------------------------------------------------•------------------------------------- ----------------------------------------------------------------------------------------- -- x 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,-- Si ned _/Ox r__40� �� - - Contractor( 9 )----------------------- - - - -- -Com---.. --- - ------------------------------- ) 13y:. -- �/� (Title) n�r `-- --- - - ---- - --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p �edeverse side). 14 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ----- - --------- ----------------------------------------------------------------- DATE--------2 °90--6 ------- ------------------- REVIEWED BY --- --- ---- DATE - - --- BUILDING PERMIT ISSUE DATE ----------------------------------- Alterations and/or recommendations:------- ------------------------------- - --- ----- ----- ----------------------------------------I-------------- ------•----------------------------- ------------------- -------- ____ ___ _ ____________________________ :_: : _ _ __ - --- - _ :_ :_::__-_::_:_:__:__ : ____:_:__::_____:_:__ --------------------------- ---------------------- - ------ - -- -----------------, --- ---------_- ------------- -- -----... - ._--.- ------------------ .___---...----------___---------------- FINAL INSPECTI BY:-- ---- - Date- / -vcri-k-7......... S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.r o. - I