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FOR OFFICE USE: =1~� ----------------------t'r ---------------__- ---.------------------ APPLICATION FOR SANITATION PERMIT Permit No. :3 :3 -------------- - (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 w rk herein described. This application is made in compliance with County Ordinance /N . 549.' , QJOB ADDRESS AND LOCATION ---------- - -- --------•-- Owner's / ��l p !v / Name .F - --------- -- --- -• Q .1�._- ..N Phon Lam_ Yl�� Address ----------- d a /�- f� tt � � AC :.. t �J i Contractor's Name-------------- --------A----W / �� ------5- .S- ---- Phone464../--(nez-_ Installation will serve: Residence I_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _'_._ Number of bedrooms _ ❑ a _ Number of baths_ --..:Lot size _- - _.l-� i Water Supply: Public system Community-system ❑ Private ❑b Depth to Water Table 7577f Character of soil to a depth of 3 feet- Sand ❑ Gravel () Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan 0� Previous Application Made. (If yes,date_-._..-I_:._.:,_-:) No New Construction: Yes ❑ No FHA/VA: Yes [❑ No� -� TYPE OF INSTALLATION AND�,SPECIFICATIONSr' � ., (No septic tank`o�cesspool permitted If,publiC sewer is available within 200 feet.) Septic Tank: Distance from nearest well:A....... ......Distance from foundation-------------._-`_-.Material __.-----__--_-._- Elj_-Xt577- No. of compartments_._ . ._._ Size Liquid depthCapacity - ------------------- R Disposal Field: Distance from nearest.well_AjO.NN(F—,Distance from foundation__/Z?---.......Distance to nearest lot line---- Number of lines l-_�<' -- Length of each line=. -�._-_Width of trench-. of filter materia!__ r--- ._.Depth of filter materia:___-./--- -- _ Tataf length_--_,3.d17`;------ °: ------- i Seepage Pit: Distance to nearest well-A/CAM..".._Distance om f undation_-. Q_._-__:_.Distance to nearest lot line_, Number of Pits_Q [.�'.�_.-.Linin'. material___- Size: Diameter_--33.1'-3."'.1f.--De th_.. P a2 ------------------ Cesspool: Distance from nearest well -------A--------Distance from foundation...._.. --_. Lining material-......---------------------------- 0 _ ., i Sze: Diameter .._ Depth -------------- --- --------------- ----- -Liquid Capacity------------•---------------gals. Privy: Distance from nearest well------------------------------- _-_.._Distance from nearest building [] Distance to nearest lot line ___ --------- t., # -� 0..: _k 4 _________________________----____-_---_-------_--_ _ _Remodeling and/or repairing.(describe):_ . p -- ------ ------------------------------------------- ----------------------- _______ r ----------- ------------------------------- _.- -------------------------------------------------- ----------.--------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that-Othe work will be done iri accordance with San Joaquin Cou ordinances, State laws, nd regulations of the San Joaquin Local Health District. (signed) !7: , }� -f' = - `---Q- S ----(Owner and/or Contractor) By---------------------- -� -----(Title} (Plot plan, showing size of lot, location of system in relat on to wells, buildings, etc., can be plac on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - j1_-.e.��` � ------------- ----- DATE ---------- ------------- -- REVIEWED BY ------- ---------- DATE__... ------------------------------- - - ------------------------ UILDING PERMIT ISSUED-------• -- ------- ----------------------------- ---------------------------------- ---- -- DATE Alterations and/or recommendations:-----------------.------------ ------------------ FINAL INSPECTION BY:. ---- ------------------- -------- - Date-- -`-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracv,California E.H.9 2M 1-67 Vanguard Press