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F R OFFICE USE: �' — --------- ---- ------ APPLICATION FOR SANITATION PERMIT Permit No. � -3 -� -------- (Complete-in Duplicate) (� l - - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordnance No. 549. JOB ADDRESS Allm LOT10N < err I. ------ - - ---- .........ZiIM Owner's Name._ .- Phone--.*61176 Address-----•---- ---------- Contractor's --------Contractor's Name--- l�`�- -KA-5--H• --- 1 ----C-1--- ------- -- -----. Phone.eff_6.ialPO ` Installation will serve: Residence j�g,. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I ----- Number of bedrooms ---4-Number of baths V----- Lot size __��_.. �--,��------------------------ Water Supply: Public system 14 Community system ❑ Private ❑ Depth to Water Table SS it Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes date................. No 1-- New Construction: Yes ❑ No K 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-----------------Distance from foundation--------------------Material ----------_...___.____..___--_------_--------. ❑ 1C�SFrc(7�No. of compartments--------------------- - --Size-------• -------- -----------Liquid depth---- ---- --- Capacity---------------------- Disposal Field: Distance from nearest weIIkf N:C-'__Distance from foundation-_2.0_,--.._.Distance to nearest lot Number of lines C-----.i*_-\__ - -----Length of each line-- __ t t J ��- -- ri Width of trench-----•�-�' ---- --- -- •--- Type of filter material —____Depth of filter material......f..�....- -Total length----_-g-Q--..Z- ' ..------. Seepage Pit: Distance to nearest well__,(,P.E!_o._I✓__--Distance om ipundafion----��__0......Distance to nearest lot line.-S- Number of pits0V-.C[_)_.Lining material --_ Size: Diameter_- - -�� Depth__. _ - -------------- l Cesspool: Distance from nearest well ________________Distance from foundation---------------.- -.Lining material------------------------------------- El 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:_` ___ ________ _ _ __ ______-------------------------- o ---------------------------------------------------------- --.._--____-___ _______ ---------- S --------------------------------- ------ -------------------------------------'-------------------------'-------- -----------------------------------------------------------------_-__-_.._._.-..__.-_--------_-_----_-___-_-_--.-____.--_-------__.-_._-_---------._._-_-___--_-__-.._.___--_-_-_.-.---..--___.-_--....- ...... + I hereby certify t have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, an rules and regulations of the San Joaquin Local Health District.: (Signed) 4 - ---- - R (Owner and/or Contractor)= By:-------------- y Title j - - ----- --- (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc., can be place reverse side). FOR DEPARTMENT USE ONLY i i APPLICATION ACCEPTED BY-------- U--k--�,------- -------------------------------- DATE----------� - REVIEWEDBY----- ------------------ -- ---- ------------ ------------ -- - DATJ= ---------------------- UILDIN PERMIT ISSUED-------- ---------------------•------------•-------------------------- DATE-- .---------------------- ----------------------------------- Alterations and/or recommendations:___.___. _` ...-.. -, ...------ �--�------------------- '`,--46�- ----- ------------ -------- ---------- ---------------- ------------------------------- ---------------------- --- ----------------1------ ---------------------------------------------------- ----------------------------------- 11 --------------- --'----------------------...----------...-_..-_---•---------'...-_-------._...-------------------------- I ---------------------------------------------------------------------------- --------------------..............__.-------------------- ----- FINAL INSPECTION BY:-.-.------- f I` b--r-y oll- Date 1. i 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 r E.H.4 2M 1.67 Vanguard Press 1 rl