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I FOR OFFICE USE: ` 4_7_----- ?*3 . Permit No. .1.. .rE APPLICATION FOR SANITATION PERMIT ---- -- (Complete•in Duplicate) ��. ------- This Permit Expires 1 Year From Date Issued Date Issued -- _- '--_-- 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. �iV 51 D d,0= JOB ADDRESS AND LOCATION J1 Z-.AAL-L#-----E407---k9F--d4CA VQr----jU Coww PP11-S--- /� / ----------.Phone Owner's Name.. p.C----CJLW.Wk1.------tl��. C.4 --- ------------------ Address-----------------1t �..' ---- 4-gy - � i2 ' Q - .,-.. rr� !! �... ...... Contractor's Name----- 1 ..� ------- -I& ----- ---- - --- ------------------------------------------- Phone.(.7b,Fk,d--,7- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel r❑�Other ❑ Number of living units: ----- Number of bedrooms.1--- Number of baths 2---"Lot size f��---.d --------------- ---4 Water Supply: Public system ❑ Community system El K. Depth to Water Table g'Sft + Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: (If yes,date. .......... ) No . New Construction: Yes ❑ No X FHA/VA: Yes ❑ No 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--------------------Material -----.-........__.------..----.---------------- ❑�jLvs,4 4115 No, of compartments-------------------------Size------------------------------Liquid depth . -- --- ------- --------Capacity----------------------- Disposal Field: Distance from nearest well---....._..__..-Distance from foundation....................Distance to nearest lot line---_------------ f ❑f t5+1�G Number of lines.----------------------------------Length of each line-- ------ --------------------Width of trench-------------------- Type of filter material____.-.----_ -___-....Depth of filter material---------------------Total length____......----------------------__.-.--.- r Seepage Pi Distance to near st ell.�SV--.....__Distance rom foundation...x. ..,.3 Mance to nearest lot lin`1 CP- Number of pits ��........__Lining material__ .�1 -. Size: Diameter-313'.2p Depth__2. "................... 2p------- Cesspool: Distance from nearest well ----------------Distance from foundation..... ........... ..Lining material._.-.-......._.......-- r ❑ Size: Diameter- -- -------------- - --- ----------Depth-- --------------------- - ---- ------------------_Liquid Capacity- -------gals. Privy: Distance from nearest well----------------- ------------------------.-....Distance from nearest building------------.-----------.-.-___....-...... ❑ Distance to nearest lot line ---------------- ---- ---------------------------------------------------------------------------------------- ---------------- -�K ,o a Remodeling and/or repairing {describe:__ . - -- -------------- ----------•------------------ - ------------- -- -------------------------- - ------------------------- -. ----_------- ------------------------ t I hereby'certif a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and r sand regulations of the San Joaquin Local Health District. I (Signed). --- : .. ------•---------- ---- --- (Owner and/or Contractor) By--------------- +�r. �. ------(Title) - - (Plot plan, showing size 0� lot, location of system in relation to wells, buildings, etc., can b t plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------- ._-------------------------------------------------- ------------ ----- DATE � � ------------------- REVIEWEDBY------------------------- ------------------- -- ------------------------------------------------ -------------------------- DATE---------------------------------------- ------------------ BUILDING PERMIT ISSUED.--------- ------ DATE----- ----------------:----------- ----------------- 3 Alterations and/or recommendations-................... ------ ---------------- -------------------------------------------- ------ ------------ ----------------- -- --------------------- ---------------- ----------- -- - ------------------------ ----------------------------------•---------- --- -----------------------•------------------- --------------------------------- --------------•- -- ------ FINAL INSPECTION BY:-------------� ------ - --------------- ----------- Date--------- ` �' - SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press