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FOR OFFICE USE: It .._-c b APPLICATION FOR SANITATION PERMIT Permit No. 1.. 6 ' -------- -------- (Complete in Duplicate) Date Issued _---------------- - This Permit Expires 1 Year From Date Issue ' 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. 549. � � JOB.ADDRESS AND LOCATION_..____ ______ - -- - _ ---- F Owner's Name---------- ----------- /___l_ Phone.__ -----------------------------------•-------- Address------------- ��3i�L Contractor's Name--------11--- �/ ------------------------------- Ph ` Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.Number of bedrooms _7 Number of baths t Lot size ----------- _- _ �''� Water' Supply: Public system ❑ Community system,❑ Private g Depth to Water Table?sft. Character of soil to a depth of 3 feet: Sand E] Gravel-ElSandy Loam F-1 Clay�Loam ❑ Clay_J5 Adobe E] Hardpan ❑ Previous Application Made: (If yes,date--------- - -------1.,No� New Construction:-Yes No ❑ FHA/VA: Yes ❑ No Elf # TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 20U feet.) _. _ d _ Distance from fountion_ ZQ-__._.Mater- L Septic Tank: Distance from nearest well---� ------------------------ No. ----------- ------- No. of compartments__--- - --- Size_ SL�-5�.�_Liquid depAi ------Capacity--/t�-0 ----'. DispoosalField: Distance from neare t well_�d_..._-_._.Distance from foundation____/D----.--Distance to nearest lot LST "" Number of lines.____r _ --___________-_._ __ Length of each line`�.�_'-757^�� -•Width of trench-'_------ - ----- t Type of filter materia!__S�_ -Depth of filter materialZ_9Z--_-___Total length____ t t� r ./� - Distance to nearest lot line. Seepage -st: "Distance to nearestwelld-__-_.:_-_Distance f om f¢undation_ ___ ____________ - 3 - ----Depth------°Z s Number of pits--- -------------Lining material-__ _- .- Size: Diameter____ I Cesspool: Distanceifrom nearest weli____.__.__. _._Distanee from foundation._._._..- _Lining material-------------------- (d L ❑ Depth--------------- from - ----- •--- ------------ Liquid Capacity_`--:---------------------gals. 3 ------------------- PrivDistance p1e frotm nearest well.___-._____---------------------------------•---Distance from nearest building--_-_-_________-,�--------------------- Y - ------------------------------,r .Y , ------------- ❑ Distance`to nearestlot line------------- ----- Remodeling and/or, repairing (describe)-------------------------------------- ------•-------------- - ----- -• -------------- ----- H '�--•-- 9"---------'--------"----'--------'------------------------------------------------•------�-------- ... � i4h■ , o- I hereby certify that 1 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. " and/or Contract ------------ ---------------------------- (Signed)-. :_. __. (Owner a d/o or) � ,c q --------(Title)----- f By:-------- - --- -- ------- `` (Plot plan, showing size of lot, lova ion of system in re ion to wells, buildings, etc., can be placed,or}oreverse side). I FOR DEPARTMENT USE ONLY . ------------ APPLICATION ACCEPTED BY___._ . DATE__ ---- -----------------------[ ----- APPLICATION IDATE-----------------------------------------7----------- REVIEWEDBY-------------------------------- ----------------------- --------- - -------- -------------------------- BUILDINGPERMIT ISSUED----------------------------------- ------------------------------------------- -------------;----- DATE----- --e --- ------ ------------------------------- Alterations and/or recommendations:----------- --- ��- f`� �z'W. �- y_�-------` -�-------- } -- - u. ------ -:= -' ---- ------------------ --------------------------- ------------------ - F Date--- ��-L- -: �1f �/ --�---- ------ r " FWAL INSPECTION BY:-._-.��- - � ----- -- ------- SrJOAQUIN'LOCAL HEALTH DISTRICT 16o1 E.Hazelton Ave. 300reet r 324 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ' Manteca,California Tracy,California F.P.G O. !