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FOR OFFICE USE: _Ad ! .^6 APPLICATION FOR SANITATION PERMIT Permit No. -- -----------•---- 3_; fp- ----- (Complete in Duplicate) Date Issued a--=1-- `-- 17 '' This Permit Expires 1 Year From Dat Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work erein described. This application is made in,compliance with County Ordinance No. 549. X13 OB ADDRESS AND LOCATION --- -_ 1 -------- ---------------- Owner's Name-- r1 ----------- Phone ---- -- --- -- ---- - y .----------------•-------•------------------------•---•--------------------••---•--•---••-- Address------------/- one ----- -❑-------- •-----------------�--------- Ph ..---------•---------..------------ Contractor's Name------ --•---------------------------••------- -=------ -- -- - - Installation will serve: Residence {g'Apartment House ❑ Commeraal Trailer Court Motel ❑ Ot�er❑' - ,r Number of living units: _-_'�--- Number of bedrooms __ :_ Number of baths -r Lot size _--_-- Private De th to Water Table .� ft. Water Supply: Public system ❑ Community system ❑ � p Character of soil to a depth of 3 feet: Sand ❑ Gravel andy Loam ❑ Clay Loam ❑ Clay [Adobe ❑ Hard No pan ❑ Previous Application Made: (If yes,date---------- I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` �a2_43__ ------- "----------- Septic Tank: Distance from nearest well=D, '�._-v6__Distance from fou ndation_- ---------------Mater al-.___ a �' X=- i ui -Capacity 96-QP No. of compartments- --�------ -----------Size---- 4 i q d depth s �f Disposal Field: Distance from nearest wellx �._-..-Distance from foundation__�1 ....8----.Distance to nearest lot line__47 ` - -__-. Number of lines.--3--------------------------- Length of each line-/oo-='.S'�---------------Width of trench. Sl-- ,--------------------- Type of filter Depth of filter material-1Z---------------TotaI length -_.----------------------- Seepage Pit: Distance to nearest well----._-------------Distance from foundation-------------------.Distance to nearest lot ❑ Number of pits------------------Lining material-------- ------------..Size: Diameter---------------- ----Depth------------------------- Cesspool: Distance from nearest well-------------'_--_Distance from foundation-------------------- material---.----.__.---"----.----------------. l ❑ " .De Liquid Capacity gals. Size: Diameter---- -----------------F-- _Depth Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- ---------- ------------ Distance to nearest lot line----------------------------- ----- --------- --------- -------------------------------------- Remodeling and/or repairing (describe):-------.----------------------------------------------••--------------------------------- ------ --------------- ------------------- •----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cer+ify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. j7 _--------------------------(Owner and/or Contractor) G 5t ned - ---------------- f - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` DATE d I APPLICATION ACCEPTED BY- ------ - - --- ------------------------------- ------ f , ----------------------- REVIEWEDBY------------------------ -------- ----------- ---------------------- ---------- -------------------------- DATE- ' BUILDING PERMIT ISSUED--------------------------------------------------------- ------- -------- ------------------------- DATE--------------------------------------.-------------------- - -------------- r Alterations and/or recommendations:--------------------------- ------------------------ -------- - - ------------- . - ---- ----------- ___11 --- - �------------ -�--- - - ,,�-tom- _ �`��- ,d� -. - _- - -------------- FINAL INSPECTION BY:---------��------------------ --- ---------- Date-_..----------- / �4- -------------------------------- ------------ 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 Tracy,California F.P.co. L