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FOR OFFICE USE: " ... . . ----------------- k APPLICATION FOR SANITATION PERMIT Permit No. ...�-.... --•-----• ----�--- ------------------------------- ---------------- > (Complete in Duplicate) Date Issued - - --------- x ' =This Permit Eio ires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for W permit to construct and install the work therein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----.3):S_&------- ----MAk— ._. r --------------------------------------------------------------------------........... Owner's Name_-. 1 � 1l _•. ' _ I "7-V-"`' - ._. Phone-----_---------------•-------•--- --*----•---------- - Address-----•--33-1- ---.- -------- IC-140 ------- Contractor's Name----- = Phone -----.-- _ -- i Installation will serve: Residence C] Apartment House'[:] Commercial E] Trailer Court ❑ .Motel ❑ Other C41UI `Number of living units: -'.'- Number of bedrooms _---r-. Number -of. baths -_ Lot size Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table-- ft. Gravel Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: ,Sand ❑ ❑ /� Previous Application Made: [if yes,date------------------ } No New Construction: Yes to❑ FHA/VA: Yes ❑ No TYPE OF INST QN AND SPECIFICATIONS: (NoAeptic tank':,or cesspool permitted if.public sewer is available within 200 feet.) - h, k. "'� _Dis#enc from foundation_1Q--"1-"-----.Mate ial__ A - ------------- Septic T T Distance from.nearest well---------------- _ ---- ---Size_- t_-_��.`-�---�Liquiddepth y Capacity. No. of compartments------- ^"~- t. Distance to nearest lot line -�---�" Disposal Field:. Distance fromnearest well-�°'"_6----=--Distance, from found ation ......:....... Number of lines-_-�,;- ---------------•-------Length of each lin e_" "`_ :_!_Width of trench. ---_--- •• otal Type of filter:material__ - ----Depth of filter mate4ial. .1 _ �stance gohnear line----------------- ,. _.._ i Seepage Pit: Distance to nearest well--------'--------------Distance from foundation--..__...-- De th_-.-----_-------..------------ of pitCA Number s---------------------Lining material+..__---.-------- ---Size. Diameter---------.----------- - P I Cesspool: Distance from-nearest well----------------3Distance from foundation-..----.---.-------.Lining•material---_..-__-__---_--.._--...._--__..- p �... . ,, --------------•------ Size: Diame er_'-'°o-------------- `Depth ---------- -•--------------------- --._Liquid Capacity. gas rr --------Distance from nearest building p' Dist nce fro4 newest well f ------------------------- Privy-, ---- --------- { Privy:, _ . _ . _t. .... ----------- -- -- ----- ❑ Distance toearest;lot line t-------------•----------_----------------------- Remodeiinglan;d/._or .repairing {d_ scrsbef --------- --••-----------------•------------------------ f ---•--------------------------------- --------------- ... ------------------------------------------------------------, -- - ---------------------•- --•-----•••----- ----- -----ce--- €that I have-1 ----------------- ' -1 I hereby y prepared +his'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. el? --------------- - •-------- -(Owner and/or Contractor) Si ned - - --_�h-------- ---------------------••----•----- ---•-(Title)----------------------------=---------- -------- ------------- I sr� -- - ----------------- I. (Plot plan, showing siz of to+, to*a bion a# system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY `-------- ----------------------------------- DATE-------- - ----------- ----------- --------- APPLICATION ACCEPTED BY------ y- REVIEWED BY--------------- _ --, DATE BUILDING PERMIT ISSUED---- - ----------- --- -• -¢ s_---- r SL.-tn,-...--==•-=--�-- Alterations andl- rAr ommenda+ions:--- -'_--�- -x = - �'.t}c. ... 5 •-•---- y, ��i I p T �`h r lin--s._ ,E,. ••-1��9--5--------Y`s-- ------- ------ - -- sl- :'� 4' -- ---- " i `"------- ------- ----------------------------------------•----------- ------------ ------------- 'q FINAL INSPECTION BY:--:-.' - " ------------------------------ -- ate- ------------- ------------------------------ -------------- SAN JOAQUIN LOCA6 HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California lodl,California Manteca,California Tracy,California EG-9 RCV/e6C e•69 r.P,90.7M 6.60