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FO OFFICE USE: Y�//`3�i � _ i __._ APPLICATION FOR SANITATION PERMIT Permit No. Zai-_.. .. --- ---- -- -- ........... -_---------------- --- ---------- -------- (Complete•in Duplicate) �� 6 / ---------------------- This Permit Expires 1 Year From Date Issued Date Issued _ __._.___ __C�?� 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 rriade in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.__*7 P�- R l ---------- s"1 OZ11- wner's Name �,1'V =r l --------- Phone._.__�(a — 't h6f ! s Address ' ©� + ---------- •------------------ •--•---------_--- Contractor'•s, Name--- -- - -- . - -- -- ---- - ------- --- -- - ------------------------------------- Phone------ -------- _-------•--- t r Installation will serve: Residence Apartment,Hause ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t#�Iivin"g units: __�' Number of bedrooms__._ . _._ Number of baths P.2--- Lot size .___ .__ ____..___....... ........ _.. -. Number-of - Water Supply. Public system ❑ Community system 0 Privafe Depth to Water Table ..... . ft ,Cha4acter'of soil%to a depth of 3 feet• Sand ❑ Gravel ❑ Sendy'Loam ❑ Clay Loam❑ Clay ❑ Adobe ffeHardpan ❑ Previous Application Made: 'llf yes,date_------ -- --- l; No [ New Con 'ruction: Yes e No ElFN� Yes No E]ter•:;- � ► �- ;� �. !1 TYPE OF INSTALLATION„AND SPECIFlCATlONS: " (No septic tank or ce400l permitted if'�public sewer is available within 200 feet.) 8 Septic ank: Distance from nearest well-:k ..--Distance from foundation--_-/Q-__-__-Mate Material ___�_�_�__�-_-_r.--____.__.... No. of compartments--` 2 --___---._.-.Size.y4_ ;(1P—�`-�-_LI uid de th___--__ Capacity-,/ O� .-. Dispos Field: Distance fromN-, rest well-.�Q... ._._Distance from foundation-----.f..9�__._.Distance to nearest lot lines_-____._____ Number of lines -_.-_---_ . �} Length of each line------- _.% Width of trench-- --�--------_________________ Type of filter material._....�t"+._.e_.__Depth of filter material__...___ ____.._.Total leng+h_._.._�.SQ______ __________________ Seepa a Pit: Distance to nearest well__:_../A0�"._._Distance from foundation------1Fd_______.Distan e to nearest lot line--______________ Number of pits... __� .__.. Lining material--_---��2_�__ Size: Diameter------_a __...__-Depth___ ------- ---------- , Cesspool: Distance from nearest well N--------------Distance from foundation In.:::......___-_ -.Lining material-------------------------------------- El iI Size: Diameter- -- ---------- -------------Dep-K------------------------ ----------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---- ----------------------------------_........Distance from nearest building-...-_-.------__.--.--_,-.-_-...__.._-.-. 4 ❑ Dis+ance to nearest lot line___________________ ' Remodeling and/or repairing {describe)--- --------------- ------------------- -- -------------------------------------- ------ , r I ------------------•------------------------------•------ ---------------- .i _ T ---------- ---------------------------------------------------------------------------- --- �x ► ----- - -------------------------------------------------------------------------------------------- --------------------------------------- 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 the San Joaquin Local Health District. I F M Contractor) (Signed)----------------- ------ �-dml/or tor) .�-------- ---- ------- Title----------------- --------- - $Y= ---------- - - ------------ ----`------ - { ) 4 (Plot plan, showing size of lot, location of system in relation4 t wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY ;, APPLICATION ACCEPTED BY - -ev----I- v...r- r---------- -------------- DATE. 2 6.5 REVIEW.ED'BY---------------------------•-------------..._..__-------------;-- - --------------------------------------------: --------- DAT E..-.-----------------------------------------------------'.. -- w. ..- BUILDING PERMIT ISSUED-------- -- ------------------------------------------ -_---•-------------------= ==----- - - DATE.. Alterations and/or recommendations;__.. ----------- ------------------------ --- r ---- -- ------------------• -------- ---------------------------------------- �+ J` --- -- -------- 7~ )- - FINAL INSPECTION BY:--------------- L.. . -- -- --.-- Date. - - f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street i 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, CaliforniaManteca,California Tracy,California 1 E.H.9 2M 1-67 Vanguard Press r ��