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FOR OFFICE USE: = .----------- • . = � .-- 6 � Permit No. . -.-.----%- - --------------- APPLICATION F�__. SANITATION PERMIT l R7 (Complete in Duplicate) ------------------------. J ; --------- ---- --------- Date Issued --- / ThisPermitEx Tres 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. 5493 E�rGLY* VV i •� C} i JOB A RESS AND LOCATION = SY44•- C. - I r >' t (r wner's Name-------- -.... -------- ----------- --' - a.'1y�4: a�l In �`c�5 Phone. '= KAY T + .. Address -------------------- ;� :j Contractor's Name t> f -' i- r --k°- :> - _ ------------- Phonei_._ .�.1:� 7 �s Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I.,. Number of living units: A---- Number of bedrooms b��__'__ Number of baths ---!--- Lot size ____ _______-•__________________ { Water Supply: Public system 6d-*�C,mmunity system [I Private [I Depth to Water Table .- _�_ ft. Character of soil to a depth of 3 feet= Sand ❑ Gravel El Sandy Loam [I Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date._-- �_1 No New Construction: Yes [�No E] FHA/\/A; Yes ❑ No 1[}' TYPE OF INSTALLATION AND SPECIFICATIONS: I I (No septic tank or cesspool permitted if,public sewer is available within-200 feet.) ar,,q.t �. Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material______________.___--______._-________.---------- No. of compartments------- ------------------Size-----------------------•--------Liquid"depth_....---------------------Capacity--...;._._-------- --- I Disposal Field: Distance from nearest well_________________Distance from foundation_______-__-._-.-_-.Distance to nea'r'est lot line------........... Number of lines__::_ '--------------------------Length of each line------------------------------Width of trench--=-------------------------------- Type of filter material-------------------------Depth of filter material--------------------._Total length-_-__-__--_..._.-:...---------------____:_ i Seepage Pit: Distance to nearest welLN1A`_%_t _____DistanCe from foundation_..�!_s_________..:Qist nye to nearest Number of.pits_______j--------------Lining,material-----N _--Size: Diameter___- _.__. p 1 Y I - Cesspool: Distance from nearest well______________._Distance from foundation...._I._.._-___---.Lining materiai______.____._____________:___:_______ ❑ Size: E)iameter --------- -------- Depth :--- •------------------I-----------.Liquid Capacity----------------- Privy: Distance from nearest well _____________---------------------_----------___Distance from nearest building._--------------------.........._______._. [� Distance to nearest lot line--------------------------------------------- �? t---.--••---.I--.-------------------------------------------------------•------ ---------- 1 - R�modeling and/or repairing (describe):______. -r -.._._ -.------- -----•t=--- _ �^--x:___--_- -----------------•-----------------------I-----------------•-----------------------------------------------•- -.._.-_--- --------- = a - s � --------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------- = ---------------------------=--------------•-----------------------------------------------------------------------------•--------- -•-----_... -------------- I hereby certify that I have prepared this applicafion 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. (Signed)- r ------------ -----------------;-----M----........................... --- -----(Owner and or Contractor' --------------- --------------------------------------------------{Tt1 --------- ---- Plot plan, showinb size oi?'lot, location of system in relation to wells, buildings, etc., can be placed on reverse sfae). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---------------------°------------------------------------------------- �--�.� � 'QATE [ 4 L REVIEWEDBY-------= '-'='---------------------------------=-------------------------------------------------------------------------. DATE------•--------._..----•----=------------------------------ BUILDINGPERMIT,ISSUED----------------------------------------------------------------------------------------------------- DATE--------•-------------- ----- - - teations nd/or recommendations:-----------------=---------------------- --•---------•--••----------------•------•----------------------------------------•---------=-------------------------- ------------------------------ -------•------- --- - _ - -- -- --- - - ------ ----------------- -- ---- ---- -------- --- - ------ -- -------------------------- --- -- - -- . - --- - --- --- - --- e c. ----------------- -------------------------- 1 �y c FINAL INSPECTION BY:. .. - -- -Date-----------------/- {f�=- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB-9 REVIB EO e•59 i.P.0 D.SM 6.6a � {