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FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT Permit'No. .C�-U ` - ------------------------ - --- -------------------- --------- (Complete in Duplicate) -� Date issued ----------------------------------- --------------------- This Permit Expires 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 hereinAiscribed: This application is made in compliance with County Ordinance No. 549.- _ JOB ADDRESS AND LOCATI N.W. --- ---I&Ije J8-7-- ---`- •• -- -------- ""�' -------------------- !, Owner's Name_ q.---,T - Phone.i!� d-- vdl _-)--------------- Address-------- f - '- ------- --------- e Contractor's Name------ Phone L�r� '� '3��'/ Installation will serve: Resi encs .) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [Q' Number of living units: ---.-:_ Number of bedrooms -------- Number of baths/-210- ____--`. �1 ___it-- -------------------------- Water Supply: Public system ❑ Community system ❑ Private 2j-*`5epth to Water Table 40- 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................:...) No ❑. New Construction: Yes ❑ No U;oo'F'HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tana ,- Distance from nearesr well-- -. --Distance from foundation- 0-. - ----_ -.----Maternal_. _- No. of compartments---1C;1 L----------- - SizeX-s_4%K-,.72--------Liquid depth.....0----------------Capacity--- .___-._-- , Disposal F• d: Distance-from nearest well... -----Distance from foundation-1Q_i----.--Distance to nearest lot line��- Number of lines.---__ � .---------Length of each line-- Ci--"_-yQ-----.Width ogtrench__-_-- .- --___--_�_.----_-- Type of filter material-A5i__.PdA k Depth of filter material---/ ----.Total length-. ---------------r- _----_...-- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.---.Distance to nearest lot line----------------- nNumber of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-.------------------------------- 000. Cesspool: Distance from nearest well-----------------Distance from foundation----------_-----...Lining material-------------------.-------------._--. Size: Diameter-----------�:- --------Depth--------- ----------- ------------------ -Liiguid Capacity----------------------------- :� � f Privy: Distance from nearest well---------------_.------- --- ------------------Distance from nearest building._. ---------------------------_----------- ❑ Distance to nearest lot line------------------------- ---------------------------------------------------------------------- -------------------- -------------- ----- Remodeling and/or repairing (describe):- / �j = _---- - --11 --- - -------------------------------------------- 007 ------------•--------------•---------------------------------- -------- -------------------------------------- - I ------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------- -------------------- --------------------------------------------- -------•------------- ------ ----------------------------------------------------------------------- . S1' I hereby certify that i 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 +he San Joaquin Local Health District. r d Si ned -- -- ".�-- ---------------- -- --------------------------------------(Owner and/or Contractor) �' -- ------- - Title ` t. (Plot plan, showing size of lot, location of systiOn in relation to wells, buildings, etc., can be placed on reverse side).,, FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY-------------------------------------------------------- ---------------------------------------- DATE --------------- '-I REVIEWEDBY----------------------------------------- -------------------------------------- --------------------------------------• DATE '.- -h? G. DATE -- r z_7 'C'. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------ -� - _ ----- ----------- Alterations and/or recommendations:--------- ---------- - ___J------------------------------------------ 11 --------------------------------- -------------------------------------------------------- ------------------- --------- ( - - ' .FINAL INSPECTION BY:. ------ ----- -- ---------- Date - - --------------- ---------------- - -------- - -- --------------- ----_ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street f Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.