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rvm vrri�_t ubt ------ ----- -------------------- --------- APPLICATION►FOR'SANITATIQN PERMIT ' Permit No. __.f-f...7 -------- ----- ----- ----- --- -------- --------- {Complete in Duplicate} _ This Permit Expires 1 Year From Date Issued bate Issued ___--- d-•�G�j Application is hereby made to the San Joaquin Local Healfh District for a'permit fo construct and install the work herein described. This'application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO s Owner's Name-------•---__-`--��TIO Address. f--�Q-- ------ Phone------------------------------------ ------ - -- -- Contractor's Name_ -------- ----------------• ----------••-------••------•-------- -`rve: 'k` -,enc ,..--� ► one - ------ -------•------ Installation will server Residence [] Apartment House ❑ / Commercial ❑ Treil r 4u, r 0 "`Motel O'�OtherNumber of living units: ____.___ Number of bedrooms __ _._.Number of-bafihs5ize ____.. f ,l Q x •_ r ------ Water Supply Public:system Communit s;stem f Y Y ❑ =Private ❑ Depth to Water Table �Qft.,, Character of soil to a depth of 3 flet: Sand ❑ Gravel ❑4 Sa-dy Loam ❑ Clay Loam ❑ Clay ❑.f Adobe ' Hardpan ❑ Previous Application Made: (If yes,date____-__--_ ' 1 No ❑ New Construction: Yes No ❑it FHA/VA: Yes ❑ No ❑ TYPE SOF INSTALLATION AND SPECIFICATIONS: f ` (No septic tank or cesspool per if ublic sewer is available within 200 feet.) ' f Septic Tank'f. Distance .from nearest well__ Dista ce from foundation_._!.__ Mafierial____ � ` No.'of compartments--- _ ' J '+ p Li :,-,-Capacity., _r--- -ate - ,,,----------SFze 5-�{---------- Guld depth- - ---- - - -Capacity., Disposal Field.' 4 04 Du#ante from nearest well. �(JI�-[ ) Number of lines------ / __Distance from foundation./4..--_.J--Distance to nearest lot line______ ____S.; --- ---.-- i Length of each line------------------- Q__---Width of trench____-___..�`C `r 41. Type of filter material- OGL - �j _. Depth�of fllter_.material__ __ _ . Total length_______ __________________Tv_- R ' ------ Se e Pit-: Distance to nearest) eldation-/- awl ` # r Distance m fo -Q -.__.Distances to nearest lot line__ _.E_------ Number of pits._ --_____._-Lining material E _ r .Size: Diameter_.., -- -----Depth------ Cesspool: Distance from nearest well-____'__.___.. Distancerfr m foundation_----------____'Lining material___.____-._________,____ _ ----- ❑. Size: Diameter Depth ----------------- -- - -------- J- --Liquid Capacity- ----- ---gals, ` Privy w _.,. . Distance.from nearest well ;..______.___-____- + - ____.______._.._Distance_from,Tnearest building-- --------------- ......, Distance to nearest`lot line.__-_.-_______-----_ . 1, —1 & __ -n:- --------- ---- ----------------------------------- Remodeling'and/or repairing {describe) --- -_--s--- - --------- - ___________________________________________________________________________________________________________________._.__---- ! hereby cert' that I have prepared this application and that the work will%i done'in accordance with San Joaquin County ordinances, Sta la and ru! anaeo tions of the San Joaquin Local Health pistrict.(Signed)- ---- --------------------------- ----------- -- --- -- --- end/or B - --- ---- - --- - ----- yvn a Contractor) Y� ------------- ----------------------------------- ---- ---------- . ------------- (Plot plan, showing size of lot, location.of,system in relati n to.wells, buildings`;etc can be placed on reverse side) I _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- -- ----C'ay`- ...__.,_ :------------------ == DATE-- -__0 _ # . REVIEWED BY°�''°",% ,. ------- ----- ----------------------- - - -- DATE IJILDlNGP,ERMIT ISS[JED:R` F D Alterations and/or recomm --- ------endations--------------------- AT _ ------ ------------ -----------------------•--------•-•--••--- ------ '-- TM. _ --------•--•----------•----•---------- - -- -------------••------------ --------------------- ----- ------------------ _ ---- ---------- -r. ... i -•------ t -- FINAL INSPECTION BY: Date--------/J --� _ --- -------------- il�+ ................................................. a ISAN JOAQUIN LOCAL HEALTH DISTRICT r l 16fJ! E.ka:eitan 14 Ave.. 300 West Oak Streeti 124 Sycamore Street Stockton,California L205 West 9th Street fi odi, CalFfornia Manteca,California � Tracy,California ES 9 REVI5E0 B•59 3M 3-'63 F.P.Cfl. J 1