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FOR OFFICE USE: -_----------------- - -''-} -------- APPLICATION FOR SANITATION PERMIT Permit No. cz� 5.�,� -------- �- --------- -j------------------ --- ----- (Complefe•in Duplicate) Date Issued 1/_- _-- -------------- -------------------------.------ This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOTION------ �'' �T Owner's Name------X04 C ---- --- ----------------------------------------------- ------------ -------------------------------- Phone__�3_'�.�l-t�------- Address- ---��--A-7---------/,9a--- ------.h,Q ---------------------------------------------------------------------------------------- Contractor's Name---#._<A>L1_.FE....PR_sc %TU1/G-'------_-------------- ---------------------------------------------- Phone......._------_----------_-_-_-- Installation will serve: Residence 12r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-I--_-- Number of bedrooms .:3--- Number of baths .. _. Lot size ----- . .Y "-- Water Supply: Public system ❑ Community system ❑ Private K_ Depth to Water Table :aQ- ft Character of soil to a depth of 3 feet- Sand ESf Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------- -------- ) No K New Construction: Yes g No ❑ FHA/fir:Yes [9,� No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well----J-0a..Distance from foundation-----la-------..Material�r�C i41j� �c,A�cyo�� No. of compartments-.__-..--.--)._. ...Size----9_X-4_� ._Liquid depfth-._ .r_� Capacity_L/ &_0.,yq � Igo Disposal Field: Distance from nearest well. d . ....Distance from foundation------�.a........Distance to nearest lot`Jine_-_--5"-.______. Number of lines----------- _ '"�`--(-i�-----=----Length of each line-- ------ ------------ of trench-------5---�-------------------.. Type of filter material__. _.a __._ -1�_Depth of filter material_--• -lam-_--Total length------ ......................... Seepage Pit: Distance t9.-nearest well-----______-----------Distance from foundation--------------------Distance to nearest lot line-_-_----_-.-_-_._ F1Number of pits___._.--------.------Lining material--.-________,_____ Size: Diameter------------------- Depth Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material_----------.--.---.-_---.----__-_-- ❑ Size:-Diameter- -- -------------- ---- ---------"Depth---- ------------------------- --------.Liquid Capacity----------------------------gals. Privy: Distar;ce from nearest well-------------------------------------------------Distance from nearest building____________________-----._.-_-.-------. ❑ Distance to nearest lot line ----------------_ --•--- ----------------_------------- •-•-•------------------------------------------ ------------ Remodelingand/or repairing (describe):-=----- ----------- ------•----------------..---•---------------•-----•----------•--•--•----•--•--------------•-_-------•-------•--•--•---------- -------------------------------------------1------ - --------------------- ---------- --------------------- - ------ - ---•------------- -----------------------------------------------------•-------------------------------------------------•-------------------------------------------------------------------------•-------- ---------------------- I hereby certify that l 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. (Signed)--------- - -------- -(Owns r) BY: {' --- - ------ -- - ----------- ------------------- ----- -----(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 . APPLICATION ACCEPT'ED BY ` r.' -- � --- -- -- - -------� -- ----------- --- ------- - DATE---I---'"- --------- _- REVIEWEDBY-------------------------------------------- ---------- -------------------------------------------------------- -------- DATE------_----- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------- DATE------ -------------------------------------- Alterations and/or recommendations:----------- - --------------------------- ---- ------------------------------------------------ ----------------- ----------•----------------•------------ - - - - - FINAL i T - Date-- 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 E.H.9 2M 1.67 Vanguard Press