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R OFFICE USE: -----4�to - � --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- --------------------- (Complete in Duplicatel... -1 11 . .1- Date_ IssU6d -------- .!/7 --------- -------------------------------------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the-wak-herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND jLOCATION_..,1,.s-_,��?_,-? L -------------------------------------------------------------------------- ------------------------- Owner's Name-------- ---- ----------------------------------------- Phone..47 2 .7j.0 7- j�,4 ................................. Address....... _k1T Contractor's Name---------MY.H.-t�1---------------------------------------------I---------------- ------ --------------------------------------- Phone---------------------------- Installation will serve: Residence [] Apartment House E] Commercial 0 Trailer Court [] Motel [D Other [] Number of living units: -------- Number of bedrooms ---.---- Number of baths -------- Lot size ------------------------------------------------------------ Water Supply: Public system E] Community system E] Private [:] Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [I Clay F] Adobe [] Hardpan 171 Previous Application Made: (If yes,clate--------------------) No Ej New Construction: Yes E] No E] FHA/VA: Yes 0 No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'Ptic Z5,4: /p, Distance from nearest well--_-------------Distance from foundation--------------------Material------------------------------------------------- wl V 6. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- Disposal Field: litsfance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. Number of lines-----_--- - - ------ --____--_-Length of each line-----_----------. - _--__-Width of trench. -----_--------_- ---_--_- ',. ��S rench----------------------------------- 5 It rk Type of filter material--------------------------Depth of filter material-----------------------Total length------------------------------------------ 7 Seepage Pit: Distance to nearest well------------ ---------Distance from foundation--------------------Distance to nearest lot line-------.--_---_-_ ❑ ine---------------- 1771 Number of pits______________________Lining material-------------- --------Size: Diameter__---------____-_-__-Depth__--------------------___-------- V4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------___-__ QIN ❑ Size: Diameter--------------------------------_---Depth------------ -------------------------------------Liquid Capacity----------------------------gals.14.,P Privy: Distance from nearest well____ -_________--___ ------Distance from nearest building____--_-----_-______--------_-_----. ❑ uilding------------------------------------------ 171 Distance to nearest lot line------------------------------------------------------------------------------------------- ------------------------------------------------ ReJelin g ili4/or repain (d ------- ------- -V-------0- 4 tribe e ... ------- ------- - A ----------------- - -------- .... ------------ ---------------- .......... --------------------------------------------- ------------------ �d_ --- ---------- 4 xzl --e-#Y-4,c--e------------- -o ' ;t , i----------------------------- at hefe6y certify that I ha prepared this applicat4 and that the work wilre done in accordance with San Joaquin County ,th ordinances, State laws, and rules and ulations of he San Joaquin Local Heath done tli_� d4 r . ............. ... (Signed)------------- --- -------------- -and --- --------------------------------------------------------------------------------------------------.(Owner and/or Contractor) By:------------------------------------------------------------------------ ---------------------------------------------- (Title)------------------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - ---- -- --- -------------------------------------------------------------- DATE------- - U-- -------------------- REVIEWEDBY------------------------- ------------- -- --- - -------- --- ------------------------------------------------- -------------- DATE---------------------------- BUILDINGPERMIT ISSUED---------------------------------------- ----------------------------------------------------------- DATE-------------------------------------- ----------------- Alterations and/or 4rorn d tin :----------------- - ------- ----- ----------------------- Z;Z.Z-------------------- --------------------------------- ------- ------0------- ...... --- --- ---- ---------------------------------------�?---------------- ------......r. -------------------------------------- ----------------------------------------------------------------------------------- -------------1-------------------------------- ----------------------------------------------------------- --------------------------------------------------------------------------------- --------------- ------------------------------------------------- ------------- -------- - ------ -------------- ------------I——-------------------- ------- ........... --------- -_------------------------------- IW:_ A FINAL INSPECTION BY:.-------- % - Date----------/11 ------- ----------- ------------------------- S I-ll- -LOCAL----C-A- L HEALTH DISTRICT 1601 E.Hax*lton Ave. 300 West Oak Street 134 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.120.