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FOR OFFICE USE: H •� �� 6 �_ _4 -- --------------- ' (� or 47 6��______._._. _:__ �_._�,� a ,,,(� APPLICATION FOR SANITATION PERMIT Permit No. ,1 � 42-4- (Comple+e-in Duplicate) / This Permit Expires 1 Year From Date Issued Date Issued ?__ :b 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 wit County Ordinance No. 549. JOB ADDRESS A OCATION_-- _-- p `_:_----- + , " ' ;< / Owner's Name-------- `1` �' .......... ----- ---- ------- __�'�..---- Phone- - -�- f- Address -- ..S Aro ---- Contractor's Name " . -- --------------- --- ---- ------ z- - --------------------------------- --------------------------------------------Phone _ (f"Y-_„, Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ r/ Id'` f i _- Number of baths- &_,C_Numbe o be r s . "" Lot size .--tp- -x - ,---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _?10- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe 0( Hardpan ❑ Previous Application Made: (If yes,date----------__.----- ) No 91 New Construction: Yes ❑ No 9 FHA/VA: Yes ❑ No x 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.................Distance from foundation."._---_."__-...._:.Material ❑ '' n'' No. of compartments ------Size-------------------------------Liquid depth--------- ------- ------- Capacity---------.---------- Disposal Field: Distance from nearest well 01,14,D istance from foundatio _ _.n_ 1 Distance to nearest lot lir0-4 e-_ ...-- '� [ Number of lines. - - °-_----- ------Length of each line.: 310 "-fit -_._.Width of trench Type of filter material__ f� _..Dopth of filter material.__ _ - _ __Total length___. -------------------------- Seepage Pit: Distance to nearest well. /Y0VC-__Distance from foundation-_[-_a ..Distann�e to nearest lot line----s ► _... Number of pits--- -/l�- _---Lining material__- _ `_ff _r_'�- Size: Diameter- - - ------------Depth ----%Z-1 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):___ �_ ,, ! >a ° a._ ---- ------ --------------------- ----------------- --------------------------------------------------------------------• ------ ---------------- -------------------------•-••----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law n r and regulations of the San Joaquin Local Health District. (Signed) +' • - and/or Co t '� - OwnerContractor) B --j --- }� -- (Title) ' ( �_ Y• - ---- ) -- -------------------- (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be plat reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------I_'-5'-r1 __--------"------"_-_-------------------------------------------------- DATE---------� _ 2 .-�6- REVIEWEDBY --------------------------------------------------------- DATE -- ------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------- ------------------------------- -----. DATE. AIrations and or eco men ations--------------- ------"--- ------- --------------- ----------- ------------------------------------------------------------------------ ........ _ "�K✓4+� .� _. JPO .._._ . d'�t --- ---------- FINAL ------- .. -- -- - C _ -`� ------ ••-- ��cf..,l�vzLEw-ts�J.<. FINAL INSPECTION BY: ------------------------------------------ Date ` ? .-----Y_ _-_ SAN JOAQUIN LOCAL HEALTH DISTINCT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press