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FOR QFFICE USE ------------ ---- -------------- ---- -- .�------ - ----_. __. ........... APPLICATION F(A SANITATION PERMIT Permit No. __ /175 ------------------------------------ {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 work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.....p .<-- - ---- 'w Owner's Name. -• - --- --------- Phone -------------------------------- Address-•-------y1-U----- ' ---- �= Contractor's Name-- " It�-t J° !t Phone------ 'A........... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] I Number of living units: ...- Number of bedrooms - .. Number of baths ---/- Lot sire __ ' 1 �e----'a--_-.-----..--._-.------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table� ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado'oe Hardpan C] Previous Application Made: (If yes,date----------- I No ❑ New Construction: Yes ❑ NoO FHANA: Yes ❑ No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /SOptic Tank: Distance from nearest well.................Distance from foundation--------------------Material ..--.-.-_----- _. tis No. of compartments. --- ---------- --- ..--Size-------------------- ------- ---Liquid depth .. ....---.Capacity----------------------- posal Fie Distance from nearest weft_ .-Distance from foundation.../.U__/ ---...Distance to nearest lot line•..-.------ '�� Number,of lines.-.._--/----------- Length of each line.. _ ..------�A......Width of trench...-.-, ------------------ Type of filter material..�_i.-ACh'-Depth of filter material--_/.,-0 length.____, 'U'- --------------_-.---- See�pa,qp e Pit: Distance to nearest//well..?0_431.0,.._Disfancer ,fram foundation---. �...-_-�istancp to nearest lot line--:�.......... 1Jr Number of pits-_ ...l._.- Lining material--- u. Size: Diameter_-.7-5------.-_.Depth.......f� ++`'_- _ -- i Cesspool: Distance from nearest well -------------_.Distance from foundation________-.----.. ..Lining material......_ .--_._--..--...-... ❑ Size: Diameter- --- ----. ........:.... . Depth----- ------- ------ .. -._------------Liquid CapacitY-- ------------------- ----gals. -- ------ . I - Privy: Distance from nearest wek....:............................................Distance from nearest buifding-------------------------------.---_.____. ❑ Distance to nearest lot line -------- ---------------- Remodeling --------------Remodeling and/or repairing (describe):% �°..� .-- - :.. -- "- --• - - ------------ - --------------------------------- -------- =!' ra". f * '—trt- ------------------------------- ` r s ----- ------------------------------------- - ----------•----------—-------/�-----•-------------------------------------------------------------------------- ------------------ ------------------------------- 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. -%!� (Signed)----_- --- . -- .-- -- ' --------------------- - - (Oy6ner and/or Contractor) By:-------•--'-------------------- - - - - -------- - -- -----------� � ' � - -------- - -----(Title)- - ----- ------ ------ ----- ------------ -------- --------- (Plot plan, showing size of lot, location of system in relation to/ells, buildings, etc., can be placed on reverse side). PARTMENT USE ONLY �y APPLICATION ACCEPTED BY---------. - ---- --------------------------------------------------- DATE-- REVIEWED ATE-REVIEWED BY. -- -- --- ------ - - ------ ------- --------------------------------- ---• DATE- --------- ---------------------------------------------- BUILDING PERMIT ISSUED-------- -------------------------- -- - --- ------------------------------------------------------ DATE--------------------------- Alterations and/or recommendations-;!,..... .................. ` - 4 ' " , .S _.,._ �--------------- ----- -------•----------------------------- ------------------------------------- FINAL INSPECTION BY:-------OS ` Date----. .�' -4t._ AQUIN LOCAL HEALTH DISTRICT 1601_E.Hazo.11on Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press