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FOR OFFICE USE: ' - _.y'___--.".f',�Q._ APPLICATION FOR SANITATION PERMIT Permit No. __ _.__.__ -----•---- " (Coniplete•in Duplicate} -------------- ---- -- ------- --- --�---�..-..---- - Date �"°R• �.-.�-�� This Permit Ex ices I Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. J/ JOB ADDRESS Api. LOC TION_. �` �'I- .. L._ C�I •- - - r1 _= Owner's Name--- - -----... ------------------- Phone.'if��----3�d� I Address >�� /� -! ------------•- --------------------------- `------------------------------------------------------••------- Contractor's Name �f�f�GGr-li -------------- Phone'�L Installation will serve: Residence ❑ Apartment House ❑ Commercial Vg� Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __ ----- Number of bedrooms ........ Number of baths -------- Lot size _ll// . __ _ t _ ________ ___ _____ __ _______..____-- Water Supply: Public system Community system E-1Private [j Depth to Water Table7.-4 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_--.-----_--- ------ I NOX New Construction: Yesx No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well_��Disfance from foundation_ 5_� e '-C4 Ma�na� ! :. No. of compartments_------r' -- "___...-.__Size _ 5 -___Liquid depth....... __ Capacity-"J...- -�. rte/ Dis osa Field: Distance from nearest wel �Distance from foundation_fS__Q______Distance to nearest lot IineS__ _ .-_. rt_ Number of lines.. ......... Of ..._ _ _-_-__Length of each line'i�_l4 '-___ C2._.Width of trench...._.'..................... I Type of filter mat,riaL__5' i _� _-"-Depth of filter material__ [ -------_..Total length_________---------------- Sd_--__ f \Seepage Pit: ' Distance to nearest well--------.----_--------Distance from foundation-------..-------'_- Distance to nearest lot line_________________ ❑ Number of pits--- ------------------Lining material---.-:------------- size: Diameter----------------- -----Depth--------------------------------- Cess ool: Distance from nearest well ________________Dist}Ince from foundation_"--- ----------- ..Lining material--------------__.___.._._.________-__. 0 ❑ Size: Diameter- -- -------------- ------------ Depth p r r- - - ------------------------- ----Liquid Capacity ------------gals. Privy: Distance from nearest well____________________________._- -------------!Distance from nearest building--------------------------------__-____-_. ❑ Distance to nearest lot line -------- ----------------------------------- -------- t Remodeling and/or repairing (describe):." "r_ " y --------------- r ------------------------ r' ------------- --------------- ----------------I-------------------------------"----------------- I hereby certify that I have repared this application and that_the work will be done,in accordance with San Joaquin County ordinances, S e laws, and rules apdi reg ions of the San Jo iquiri Local-He-alth:Diifrict. '. (Si ned 9 ) - - (O,wner and/or Contractor) r By-------------------- -------------------------- --- -------------=-- --------(Title /1� _.. -------------- r (Plot plan, showing size of loft, location of system in relation to w s, buildings,.etc., can be placed on reverse side). RTMENT USE ONLY r / APPLICATION ACCEPTED BY - - -- - - - - - ------- ----------------------- -------------- DATE----/1 d_-"(3 --------------------------- REVIEWED BY------- ---- --- --- - -- ----- ---------------------------- ------ DATE------- BUILDING PERMIT ISSUED-------- -- - ----------- ------------ -- ---- - ------------------------------- ------------- DATE------------------------ --- Alterations and/or recommendations:--- ----- -- -- ---- --------------------- ------------------------------------------------ •------------------ I - -� ._.. p -------- -•----- ------- ----- - ----------------------------------------------- -- • ----------- ----------------------------------------------------------- ........... ---------- ----- - ---------------------------------- - FINAL INSPECTION BY:..-------- Date----- �-`— r SAN J / UIN LOCAL HEALTH DISTRICT ' i 1601 E.Hdiellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California -Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press