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FOR OFFICE USE: -I -i. .7 - _ ----- ----------llp_'�------- ----- ------------- ------------------ ------- APPLICATION FOR SANITATiON PERMIT Permit No. Z107 -- ------------ -- -- --------------------- ........ ------- (Complete in Duplicate)- . -------- ----- ---------------.------------------1M--- ----- This Permit Expires I Year From Date Issued . Date Issued 16 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work I herein described. This application is made in compliance with County Ordinance No. 549. Z-Z - II.� 7 JOB ADDRESS AND ATIN� 0 --------------------------- Owner's Name------ - ------------------------------------------------------------------ ---------------------------- - ----- Phone------------------------------------ Address----------- ....... ------------------------------- --------------------------------------------------------------------------------------------- Contractor's Name----------tl�- -- ----------------------------------------------- ---------------- -------------------- Phone--------------------- i . i ------I-------------------- Installation will serve: Resll idence gT'—Apartment House. ❑ Commercial E] Trailer Court L] Motel [] Other El Number of living units: ---I--- Number of bedrooms---:r-- Number of baths __� Lot size -_-----------------------------------------------_--_-.-- Water Supply: Public.system E] Community system E] -Private R�rDep'fh to Water Table _AP ft. Character of soil to a depth of 3 feet: Sand 59--Gravel E] Sandy Loam E] Clay Loam 0 Clay El Adobe [] Hardpan ❑ Previous Application Madd: jif yes,date--..---..-.._- ----) No DR-- New Construction: Yes E- T�o E] FHA' /VA: Yes E] No gj-- TYPE OF INSTALLATION ll.AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--,rp -Distance from foundation--.®G---------- MaferiaJ----/----------------- No. 01 compartments--- .:Si,, �� .0 ro, -------e----------- ----- ----Liquid clep�h..... ----------------`Capacity-- 'p Disposal Field: Disfance from nearest well.-n-_--____Distance from foundation-JA_`---------Distance to nearest lot line--.-,------------ Number of lines------2........... -Length of each -------Width of french.-- ---- - Z - --- BO-- ---- Type of filter materiaf_ROCA�-----------Depth of filter material-11.--------------Total length------40V 11: Seepage Pit: Distance to nearest well---------------------Distance from foundation--_--.--.----------.Distance to nearest lot line-----.-_------_- D NumA��r ofpits--------------------- Lining material-------- - ------------Size: Diameter-----------------------Depth--------- -- --- ----------- Cesspool: Distnnce from nearest well_-------------6stance from .foundation_--------------__- Lining material--_____------..----------_----------. El Size: Diameter-----,------------------------------'Depth----.. ------------------------- - -----------------Liquid Capacity------------- _ - ..gals. Privy: Distance from nearest well----------------- ---------------------Distance from nearest building-----------_----.-----.------..------.-_. ❑ uilding----------------------------------------- 0 Distande to nearest lot line-- ------I Remodeling repairing (describe)---------------- ------ and/or I ------ ----------- --------------------------------------------------------I--------------------------- --------------------------------------------- -----•--------------- I------------------------------------- ----------------r---------- ------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ --------------------!I--------------------------------------------------------------I-------------------------------------------------------------------------------------------------------I-------- I hereby certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws a d rules a gulat* ns of the San Joaquin Local Health District. (Signed)-------- _7 �,&� _gu_,a _- ------------ By:--------------------------- ----------- ..(Owner and/or Contractor) ---------------------------- -------------------------------------------------------------------------------- By:------------------------------1-1------------------------------------------------------------------------------------------------------(Title)-------------..............I------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be Placed on reverse side). 0! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B Y DATE__ Z ------------------------ ------ --------------------------------- REVIEWEDBY---------------------11---------------- ----------------------------------- -- ------------------------------------------ DATE BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------- --------------- ---------_------------------------------------------------------------------------------------- ------------------ ---------------------------11------------------------------ -------------------------------------------------- --------------------- -------------------- -------------------------------------------- -------I---------- ----------------------j)----------- --------------- ------------------------------------- -------------------------- -------------------------------------- -------------------- ------------ -------------- ------; ------------------ -------------------- ------ ----------------------------------------------- ---------------------------------------------- --------------------------- ----------------------- ! ----------------------- FINAL INSPECTION By -- ------------------------- Date--/ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.gbzalhom�i.4ve., 300 West Oak Street 124 Sycamore Street 2 05 Wesr�9f Street Stockton,California Lodi,California Manteca, California Tracy,California F.R C 13