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FOR OFFICE USE: ._ - _ -_--- APPLICATION FOR .SANITATION PERMIT Permit No. . . (Complete in Duplicate) --------`----------- _`_--..--- -.--- This Permit. Expires.1 Year From Date Issued Date Issued - -------- --- -~3a�� --------------appy y permit � I Application is hereby made to the San Joaquin Local Health District fora ermit to construct and install-he woik herein descri ed. I This application is made in compliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATION-A// Owners Name------- ---------- ---------------------------- -- - - ---vt - FRi� Address------ .- r' r----------------------------------------------------------------------------------------------------------- Contractor's Name--------- --------• ----------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: /---- Number of bedrooms _,oZ_- Number of baths "/-- Lot size _-4W_2'`4 ------------------------ Water Supply: Public system ❑ Community system ❑ Private W?"5`epth to Water Tabl4�. . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: 11f yes,date.- ----------) No g]" New Construction: Yes ❑ No J�r— FHA/VA: Yes Aj—No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ------ Septic Tank: Distance from nearest well--- Distance from foundation--/EI--.-----Mate�al__,c-c---- - -- No. of compartments... . _----------- Size•ar, � --Liquid depth----- -�' Capacity. ------ _ ,} ! r �.. ! ' f Disposal Field: Distance from nearest weal___ �-...-Distwize_from foundatiioon_ - P7----.--Distance to nearest lot line- .---_- 0 ' Number of lines------ l_--- Length of each line__i�----W _Total hlength�c�-'---------------- -------- 9 r ----- J Type aT filter matenwell-.49441 lf� Depth of filter materiaL.� ---- Seepage Pit: Distance to nearest a -. � �__-Distance fro fo ation--O-Z**_�----Di tacce to nearest lot I�e-� ------- rn Number of pits-----/--- ------Lining material--- Size: Di8meter�,,,�-.------------ Cesspool: Distance from nearest well _--Disfance,from foundation--- --------------Linnin.g material-------- .-_-___--.---_.------ ❑ Size: Diameter-------= ---------- -- •- ---..De fh- ----------------------- ------ ------------------Liquid Capacity----------------------------gals. Privy: Distance from Weare'st,well----------------`.�.-- ------------�------------- F -_Dis+ante from nearest building------------------------------------------ ❑ )Distance to nearest lot line------------------------- Remodelin and/or repairing desci /~ ' (e' - ``` + -------------------------------------- ------------ ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- - 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�regulat*ons of the San Joaquin Local Health District. - ---- -- - --- -------.--- ---- - -- -- - -- --------------------------------------------------- (Signed)--___-------- r Contractor) By:--------------------------------------------------------------- - - ----- -- - - - ----------------------------...- -------------- ------- ------ I (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY - DATE--------- 6 --------- ------------ -r REVIEWEDBY-------------------------------- ------------------------ -------------'------- --------------------------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------r----------------------- DATE--------- ----------------"---------- ------ -------------- Alterations and/or.,recom endatio s:-------.--- --1--- -1 `� C -�- t = ` --------------r1-CC-1--------- ---------------------------------- ------------------------------------------------------------------------------------- t --------------------------- --------------------------- - - ---`--------------------------- - - ---------------------------------------------------------------------------------- ---------------------- • ----- - ----------------------------------- , t� � /� ,- FINAL INSPECTION BY: Date - l ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 245 West 91h Street Stockton,California .Lodi,California Manteca,California Tracy,California L F.P.CO. k