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FOIA OFFICE USE: ---------------------- - ----- ----- - '� Permit No. APPLICATION FOR SANITATION PIrRMIT ... This (Complete-in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued -------------- ----- ----- -- Appli;atien is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein deed. This application is made in compliance with County Ordinance Nor 549. .�l�s� ---------------------------------------------d- ----------- JOB ADDRESS AND LOC ON--------- _ _ - -- Owner's NamePhone-.. - --- --- --------- Address--- __6------- --•----- l _7. ~----- ----- ----------•--- ----- ---- ........ ------------------------------------ -•-------••--•----•--- --•----•-- �fit ------ Phone_��P----3------------ Contractor's Name-------..--- ---• -------- -----. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court motel ❑ Other❑ C]" �-u-� Number of living lanits: __/_ Number of bedrooms _.14*1_ Number of baths _.___._.. Lot size __-_ -y---- --- --- ----•--.------------•----------- Water Supply: Public stem ❑ Community system Private ❑ Depth to Water Table4'O 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 ❑ FHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: // t (No septic tank or cesspool permitted if public rsewer is available within 200 feet.) &tc-1 SepticT nk- Distance from nearest well__�.�.'.._.____Distance from foundation___/4_.-__..Material .:�L�.... ... . ....._ ._._...__ - Capa( f�� n No.fof compartments----- --Yr>c�,- Size_9X - -:-_.Liqu d depth_... ....... - -- P Y Disposal Field: Distance from nearest we{l_S ._.__--Distance from founds+ion----14. ......Distance to nearest lot line---S_.._ Number of lines.-----�----------- ---------Length of each line-----.-9.4-.---�<<---.Width o trench....__ -y----._----------- Type of filter materia}___- - S/1 __Depth of filter material___��._..__i_Total length------_.____,l_. W_ ____'____-_ f _ , -___--.Distance to nearest lot lineI''S___-.-.__._ Seepage Nf: Distance to nearest ------------ w ZAP___._.._ Distance�yyf��rom fpundation___. 3 L Number of pits.-- _�_---------Lining material__[�<�_. Size: Diameter._---------------Depth-.---�'�----------------...' Cesspool: Distance from nearest well ________________Distance from foundation----------------- ..Lining material_-----------------------.._--______. C ❑ Size: Diameter- -- --------- ----- ----------- Depth----- ----------------------- --------------.Liquid Capacity- -------------------------gals. Privy: Distance from nearest well---------------------------------------.----...._Distance from nearest building-___.__--..-______.______--.---._._..__--- �• 0 Distance to nearest lot line . ............... ------------------------------------------ ---------------------------------------------------------- ------------- , Remodeling and/or repairing (describe)--- --------------------------------- •--------------------------------•------ ------- ---------------------- ----•------------------- -- ------------------------ -------------------------------------------------------- ---- ----- ------_----------------------------------------------------------•--------- --------------------------------- ---- - -� I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, S laws, and rules an re tions of the San dbaquin Local Health District. - ------- (Signed)------ -- -- -------------- - - - -- ----- - .-• --.--------------- --------�y ------ -- ---- --- - - ..___ wne and/or Contractor) By:... �-- ------(Title] .... (Plot plan, showing size of lot, location of system in relation to wells, buil igs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------- f - DATE �� _� REVIEWEDBY----------------- =------ ------- - --------------- ------•'T------- -- ----------------- -------------- DATE BUILDING PERMIT.IS5UED----------------- ---------------------- -- ------- - " ----- - j -------------- DATE----------- ----------- -------------------- - Alterations and/or recommendations:------ -----G 6 -------- ys -' ----------------- ------- -------- --------- ------------•----------------------------- t -----------------------------------------------------------------------•-----------------------------------'--------------- ----------------- -------- -.;-_---- --------------- ------.-- FINAL INSPECTION BY:... � C� ,----------------- Date----------��- ��--- ---------------- r� �� ---- i - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California EM,9 2M 1-67 Vanguard Press