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vac vrnk.0 U3L. - ------ ---- A ----------------- - ------ -- ----------- ------ APPLICATION FOR- SANITATION PERMIT Permit�4No. .Q ---------- (Complete in Duplicate) a ""- ---------- --------------------- - °- -------- This Permif Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for apermit t str ct an install the work herein described. This application is made in compliance with County Ordinance No. 549. y JOB ADDRESS AND LOC TION__"-- -- E /Q �� Owner's Name----- - 14- ± �r - - ----------------- ----- Phone. ¢_ - o ` f -------------Contractor's Name---------- - • -- ---- Phone _ 49 7 ---- Installation will serve: Residence ❑ Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: I_- Number of bedrooms _r_L. " Number of baths J.____ Lot size Q __ Water Supply: Public system '"' �{ pP Y' y ❑ Community system ❑ Private Y� Depth to Water Table /00 ft. u Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam J Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No� New Construction: Yes ( No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weN_�0D r Distance from foundation_.__ __ ° f f9_____--Material_._-_ ! � No. of compartments_____ ------ ------- ---- ----------Size-----�V---Q-------------Liquid depth --�2.<<------Ca acit /� �J r w P YC�._, -C I Disposal Field: Distance from nearest well.. __Distance from foundation_-_ / -Ir -_"-.Distance to nearest lot line__z_e---- Number of lines___._ _._ -_-"C} _ Length of each line-_-1-16_� ' Uj Type of fitter material" / Yr--W1dfh of trench---.�c4"-t!" __--_.Depth of filter material r W r 0- Total length ---------------------- V4 Seepage Pit: Distance to nearest well-"ZQQ------Distance rom f undation--- r r -----_.Disfian�e to nearest lot line_1.p"----- Number of pits._-4 :C.�_6)Lining material- Size: Diameter___._ "_ - - - _. Depth__�_,�'. --------- Cess 001:,1 f I P Distance from nearest well__________ Distance from foundafiion_."_________" 4r -----.Lining material--------- ----------------=---------- ❑ Size: Diameter--: - ------Depth------ ------------- --- - -- Liquid Capacity_. Pr'ry - - - - --- - --- ---------gals. V� y= Distance from nearest well--__------------------ - --- -- -.-Distance from nearest buildin �" g ❑ Distance to nearest to"t line._- ------ ---- i` Remodeling and/or repairing (describe):_--___ 4------ ---------------- ----------=---------------------------------------------•------------------ - ---- ----------- ------------ == --------------------------- . ---- ----------------------------------------- - - - -- - -- - -- ....... -------------- ---- -- -,--------- -- hereby certify thaf] have p ed this application and that'the'work w' be done'in accordance with San Joaquin County ordinances, State laws, and rul and r gulations of t San Joaquin Local e h District. (Signed)------------- ------------------ ..... -- --------- ---- --- --- (Owner and/or Contractor) BY - -- ----------(Title)--- -- (Plot plan, showing size of lot, to • n of system in relation t wells, buildings, etc., can be place on reverse side). _---- ---- - - -- .... . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-___..._ REVIEWED BY _" / ---------------------- - - DATE----- -7 �' ---------------------------- - - ---------- -------- - ---------- DATE------------- ----------- ----- - - BUILDING PERMIT ISSUED------------------------- ATE Iterations and or recom jendations:-_ ---------- 7 --------------------------------------- - ---------------------------------------------- --------------------------------- FINAL INSPECTION BY:------ ----------------------- ------------------------- Date--- 4 1-- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT u 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,california Tracy,California f•.P.0 O.