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FOR OFFICE USE: --------------------------- ----------------- APPLICATION- ��'/�` ___________________ ___ ____ FOR SANITATION PERMIT Permit No. .....__.._.......-__... ---------------- -----------------I--------- (Complete.in Duplicate),-. !7 / ------------------ ... __. ----------------- }This Permit Expires 1 Year From Date Issued ...........7 Date Issued l r 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 ompliance Chun y Ordinance No. 549. .. o y 1 i, JOB ADDRESS AND LOCATI N--1'Yt` ¢' --- --- -------- y ._&.h ��aP' 'c "�Csu Owner's Name - - - ------- Phone------------------------------------ -.-------- Address � e2�� -_ ------------------- -- - -------- ----- - --- ---------- - ------------ --- -- ------- - --- ----------- r l Contractor's Name--��-•- - - --;• ._._,5�_3�-- - -- --------- -- -�--• _ '�->er.._.--- - - -- phone..-_.__-----••-----•-•-•-••-----�. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: _._ Number of bedrooms , Number of baths Lot size --- ------------------__.!------------------------ Water Supply: Public system ❑ Community system ❑ Private E!� Depth to Water Table ---- _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z/Hardpan Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,,Tank: Distance from nearest well_- o_�_1fDistance frompfoundation____/a__-F___-_Mate _ tial ________ ----------------------------- f No. of compartments-._-caZ_._._.__._.__Size-d._z l__�`%r_._..Liquid depth_-__V___--_. ---__.._. Capacity./A-.d Q._ Disposa field: Distance from nearest well.--- /----Distance from foundation---fG...`_.....Distance to nearest lot Iine,S.�. .___... • Number of lines------------ -------Length Len th of each line_______ O ' Width of trench._�_°_-_._-________________ i; 9 ly------- s Type of filter material------`f�g-_-_ Depth of filter material------l9-----------Total length----_--________________________________ ......... e See pa a Pit: Distance to nearest well____.`®a_.____.Distance from foundation----1A._____._..Distance to nearest lot line__._____.__ Number of pits-_------/---------Lining material_.__-JK------ Size: Diameter---...?-�"_.____Depth_- S__'f__________________ Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material--------------._____.--____________. ❑ Size: Diameter- -- -------------- ----- - -------Depth---------------- ---------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________ ____________________________________Distance from nearest building--____.__.________________----..-___-_-... ❑ Distance to nearest lot line------------------ -------- ------------------------------------------ --------------------------------------------------------------------- Remodeling and/or repairing (describe)------ ------------'-------•------ --- ---------•----••----•----------------------•----------------------------------------------•---------------------- -----••-----•--------•--...----•-------------------•---•---------------- -_-- ------------------------- -•--------------- - ----------•------•--------------•-•-------------------------•-•-----------•--•-••------------ --------•-•---••----------------------------------•-----------------------------------•----•--------•---------------------- -----------------------------------------------------------•-----------------------------•----------------------------------------•----------•---------------------- -------------•------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tate laws, and ules and regulations of �anquin Local Health District. o(Signed)-- - •. •--- ----- ------ ------ -------- - --------------------- -•------------------------------------(1�ee and/or Contractor) Y: `rL' -------------------- (Title_)„� --_: 0� .------ --------- lot B . ` --- - (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 APPLICATION ACCEPTED BY--_ :: __ .ez., -------------------------------------- DATE-- c = ---------- REVIEWED BY------------------------- --------- ------------ -------------------------- - DATE BUILDINGPERMIT ISSUED-------------------------------------- ---------------------------------------------- -------------- DATE.-------------------------------------- Alterations and/or recommendations:----------------- -------------------- ------_ -------------------------------------------------- --------- --- ---••------- --------------------------------- ------------------------------------ -------------------------------------- -------- --------------------------------------------- ----------------- -------------- -------------- - ------------- ---------------- ------------------------------ -- ----------------- --------------------------- ---/-------------- -------------------- ----------------...------- FINAL INSPECTION BY v kC-- -------•-- ---- --- ----- ----------- Date Q 1 < SAN JOA U't :5CAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California ? ` �rj^ Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press J l?6