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FOR OFFJCE.USE: w ,• �• ------------------------------------- ------ � 5� APPLICATION FOR SANITATION PERMIT Permit o_ _______________________ (Complete-in Duplicate) Date Issued --- ----- -- _1.i -___---.._-__---- -- -- --------_.__ --__.-- 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 wa herein described. This application is made_ t compliance with Count Ordinance No. 549. A-)eEc - �—v—Oj �J013 ADDRESS AND LCAT Off - 71-- = �. �r r err y ne .-- Owner s me f�L.�-�7 - .• ------ l ti---------------------------- ------- ---------< .--_ .._. Pho [� -V6 Address �_ - =------•-------------------- ----------- _ - ______________________________ ____ _______ ___ ______________ _____�._-______..-y.-_______ _____._._----- Contractor's Name__ ._ ------------- Phone------ •- ------•-------• z �. Installa+ion will serve: Residence �' Apartment House E] Commercial E] Trailer Court [] Motel [j Other [I4 v•-Y p Number,of living units: .I'j'Number of bedrooms _-3- Number of.baths /_._ Lot size ____./ C - -I ---------------------- .. : _ .,�. Water Supply:; Public system [I Community syst m E] Private R] Depth to Water Table _ ft Character of soil to a'depth'of 3 feet• Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:., [I.f:yes,date-------------------- I No P-4ew Construction: Yes E] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool permi+led.if.'public sewer i; available within 200 feet.) Septic Tank: Distance from nearest well----------- t___Distance from foundation_ _..:. _Material"-.� - � ❑ IN q'.' of compartments.............-. _Size----- ---=-- = Liquid depth Capacity i Disposal Fie�lc Dis ante from nearest we 4 Distance from foundation-___.1'_�.--..__Dista,nee to nearest lot Ione'(� ��-� --• Number of lines-----------~Z11_____ . . -, ..Len Length of Lach line__ _--, �. f�_-..Width of trench.----------;;?-d/_____�__.._-- •�„N Type of filter material_--R-Q.C-±K.`_;Depth of filter material____ -------- otal length-----------------!©4?------------- Seepage __---____-. (� See a e Pit: Distance to nearest well----------------------iin�matstan e from foundation Dia meter-_-_Distance' to nearest lot line-----------------11 -j P gDe th--.-. - - Dumber of Psr, 9 A P Cesspool;i.:`�- rD.istance:from:nearest-well--__�:?Distance from-foundation__...-.._ __"._ ..Linin material_ __ _..._:_. .__-____._ �� ❑ ----• --------�- �-f° � Distance from nearest buildig•--- ---- -- -------------------------- El --------- -•-9------' Size: Diameter- - De th-----=--- " Liquid Capacity.. Privy: Distance from nearest well._..__..--- ................. ❑ Distance to nearest lot line�.-----------;-' _..................... -- ------------------------ -------- --------------- -------;-------------- , --- ---------------------- ----------------------------------------------.--------------- ------------------------------ Remodeling and/or repairing (describe): .. '_ ---------------•-------•-•----------- ----------•----- -----------•-- ----- ---- - L ---------------------- -------------------------- ---------------------------------------•---------------•• ----------------• ------------------------------------------ --------------------------------- ----------- - It ---___--------------------------_--------------------_________-----------------------------------------4 ___---_._---__._______-_-_-___--_____..____..-___---__.___-__-.___.___-_-----____-_- ---------------------------------- .--------------._ G I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y� 9 ordinances, State laws, anAru4jigs and re ulati sof the San Joaquin Local Healfh District,:j C f (Signed( 9:� - -- . .. ---- - - - -------------:------ -------------------1.----(Owner and/or Contractor)• 7' { �.,_._. By:------------ _ ---------------------- ------------------------- a------------ .... _ � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.--- VCR,0.---------- ------------------------------ _ DATE-------- _ -'_� ----.------------ REVIEWED -------- --REVIEWED BY----.. ----------- ------ ------------- ------------------- ---:--------- - --------------------- DATE-------------------------------------------------------------- FBUILDING PERMIT ISSUED----------- -- -- - --------------------- ---- ------------------------- DATE--- ---------------- ---------------------- ----------------- --------------------------------- --------------- Alterations and/or recommendations:...._ ° „ti, ----------------- w:. r-- ---_— ----------------- ----------------.-. }� �� ifs �.------ ------ ------ ------------ --- -------------------------- --- ------------------ -- --.. --- ---------------------- --- ---- - -- -------- - - - - ----------------- ------------------- -- ------- ---------------- ----- -----_------------------- :----- FINAL INS - --------- Date--.----. 7----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maielton 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 CM9°' r