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FOR OFFICE USE: ___ _________ _ _ ___________-______.._-_--_--_ ------- APPLICATION FOR SANITATION PERMIT Permit No. ._C7� - --------------- ---------- -- (Complete in Duplicate) ----------------------------- This Permit Expires 1 Year From Date Issued Date Issued - A Application is hereby made to the San Joaquin Local Health District for a permit to ganstr t a inst, II the work herein described, i This application is made in compliance with County Ordinance No. 549. jf,� �3 JOB ADDRESS AND LOCATsION_A/1,0e1._ a--- , Owner's Name —4-4 --------------- ------- Phone--------------------------- Address---------- Contractor's Name---------.eeiq ----------------••-------------------------------------- --------- ----------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: _A/___ Number of bedrooms _- Number of baths _f____ Lot size _ ,3_Aedl0 ----------------------------- _461 ___________________________ Water Supply: Public system 0 ppy: y ❑ Community system ❑ Private Depth to Water Table - :eft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z3- Fdardpan ❑ I Previous Application Made: (If yes,date------ --------- --) No.p- New Construction: Yes Flo ❑ FHA/VA: Yes P;-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o oe Septic Tank: Distance from nearest well-- Distance. from foundati n__/p______._Material,!°P-.-041ef No. of com artments- p �------------f--Size, --s�6��!_�iquid de'th---�---------------- Capacityz��i��_�_�- Disposal Field: Distance from nearest well-$Pa-_-_.-_Distance from foundation__ __ ------Distance to nearest lot line_,94 ! I Number of lines------ _. g AP------_j_V----Width of trench------------------------------- i ❑L� � -.- Length of each line _ __ Z------- �� I � Type of filter material_/f_A G -_-Depth of filter material__/_�___-______--Total length___ - -- ____ Seepage Pit; Distance to nearest well___ ____Dretance from foundation__ _ ..dr._._.Dist-_Distance to nearest lot I�e_ �-..-_ `V Number of pits----� �--___-_-_-__Lining material_ f4, s Size: Diameter-_ - --- ----Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________-____-____------_- t ❑ Size: Diameter-•------------------------------ ----Depth---------------------------------------------•......Liquid Capacity----------------------------gals- � x Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------- . ❑ Distance to nearest lot line----------------------------------------------------------------•----- t . Remodeling and/or repairing (describe)-------- --- -- --------------------------------------------- -• -- 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ --------- ---- N � ------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {5i ned 9 )----•----------------- ---- -- - -------�-�'�,/-- - - ------------------ - -- ------------------------ -------------------- -{ 4or Contractor) By:-------------------- ..........------------------------------- L'E° -- ----------------------(Title)- _4,� / "`+' ------------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). i FOR DEPP7ARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------------------ 4/----- ------------------------------------------- DATE------ -------!'--//z�16. REVIEWEDBY ---------------------------------------------------------------------------------•--- DATE-- •---------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------ ----------- Alterations and/or recommendations._-_-- -__- -I-,/- ��_--_ _L-__ -. _ . - FINAL INSPECTION BY:........ ___- -- G - --------------- Date ---------- ------------------ -/ . -- - - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.