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FOR OFFICE USE: .............. APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ------- (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 herein described. This application is made in compliance with County Ordinance No. 549. _1Z, �dol Aft I ----- ----- ------4W---- ------- JOB ADDRESS AN%LQCATION---Y11_._54 _X-) ' 5� AMC--- bm"__ 1Z,4 Owner's Name--------- -------- 4=55, W---/----7_77—------ ------ -------------------------------------.,. Phone------------------------------------ �44 _0----------5 t7k6Mn ------------------------------------- Address----------- ......... ...... CAP, - -G7 & .... 2 Contractor's Name----- - P'A IF _ -. --t- r ----------- *------ --------------------------- ------�.r/1) Phone____4 el YA(77 Installation will serve: Residence Apartment House ❑ Commercial E] Trailer...Court E] Motel [] Other [:] Number of living units: Number of bedrooms -Af- Number of baths. Cot size -------------------- Water Supply: Public system El Community system [� PrivateA Depth to Water Table P.,, ft Character of soil to a depth of 3 feet- Sand E] Gravel El Sandy Loam F1 Clay Loam Clay 0 Adobe [-] Hardpan F] Previous Application Made: (If yes,date_------ NoNew Construction': Yes No E] FHA/VA: Yes El No 0. TYPE OF INSTALLATION AND SPECIFICATIONS: x 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic'Tank: Distance from nearest well-140.....Dista2ce froifounds tiort-j-0--------- No. of compartments--zm--------------- _Size-*-X _PLiquid depth ---------Capacity- Disposal Field: Distance from nearest well .-Distance from foundation__ .......Distance to nearest lot line----:$r_10 - -------A-..-Lengfh of each line__ ft ---e- Width of trench.,ezd----- - ------- Number of lines ---------d-1-1 ?0- Type of filter material-----".V�-� __Depfh of filter material__-------11-1-1-3otal length_________----------Ay9!1R2n_,!_ Seepage Pit: Distance to nearest well......................Distance from foundation________________.._Distance to nearest lot line._______.___.-.__ ❑ ine------- ------ El Number of pits--- ------------------Lining material---------------------- Size: Diameter-----_------------__-_-Depth................... Cesspool- Distance from nearest well ______._..._.._Distance from foundation__- 'Li.ning material_____________________________________- El Size: Diameter- -..Depth-.** ---------------- -----_---------------------L uid Capacity-- -------------------------gals. Privy: Distance from nearest we]--------------- - -------------- ---------- - -Distarce from 'nearest building.___.__.___ --------------------------- F-1 Distance to nearest lot line- --- --------------------------------------------- --------------- 4model ing and/or repair Jng (describe):----- ------i�-------Z�l ------ ------ ---- - ----—-------- x—---- --------- - --- -------------- - --4---------------f i ------- ------ ---------- --------- -----------------I--- --- ------ --- -- - ----- ------- -- ----- -------- ------------------------------------------------------------------- ---- ---------- - ---------- --------------------- ---------------- --- ------------------------------------------------------------------------------------ ------------------------------------------------- I hereby certify that I have prepared this application and that. the work,will be done in accordance with San Joaquin County ordinances, State laws-,_'$nd rules and regulations of the San Joaquin Local Health District. .0,000, ........(�.......{Owner and/or Contractor) (Signed)------------------I.- .41�----------- --- -- -------r---------- - -- By: -------- ------ howing ------- ---- ze` t, ocation of system in relation to wells, buildings, etc., can be pace on reverse side). _0 (Plot plan, on FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BDA ----------- T' ---------------------------------------- REVIEWED BY----------------------------------------------- ----- DATE-:.- BUILDING PERMIT ISSUED-------- -- --------------------------------------------------- - -------------- ------------------- DATE----------------------------- Alterations and/or recommendations------------------ --------------------------- ---- -------------------------------- ------------ -----------------------------------------------:- ----------- --------------------- -----------------------------I---------I------- -------------------------------------------------------------------------------------------------------- ------- -------------------------------------- ------------------------------ -------------------------------------------------------------------------- ------------ ----------------------------------------------------------------------------------- ----------------------------------------------- ............. .............. ------------- -- --- ----e- ------- ----------- - -------------------------------------------------- -- --------------------------- ------------- -"------ -------------- . ............ -- ---------------- ------------- ---------------------------------------------------------------------------------------------I--------------------- FINAL INSPECTION BY:.. Date........... -- ---------- -------- --- --------------------------------- ----------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California' E.H.9 2M 1-67 Vanguard Press