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FOR OFFICE USE: po _ -------------------------------------------------------- APPLICATION FOR SANITATION -PERMIT Permit No. .........•...... ------------- ---------------------------- --------- (Complete-in Duplicate) Date Issued ,,��_-:f.�__�� __.-_.._..__.____________.__ 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 o. 549. JOB ADDRESS AND L CATION____ ........ o S � �� -- ----------------- Owner's Name--------- ----L---- • . ----•� . - ---- -- ------ - - ------ .. Phone.4`� __3Z-7-r Address.......................- ..... --------•----------`------ ---------- - -----W------ --------------------------------------------------------- ........................................... Contractor's ----------------------------------------------------- - Contractor's Name------ -• •. ----- ..... .............. -- --- ' —�� Phone.��-1v&.A6V7.. Installation will serve: Residence ;K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms _7-'_._ Number of baths I----.- Lot size __7_5_X....LS�----------------------- Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table 7-S—ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeh2t Hardpan ❑ Previous Application Made: (If yes,date------ ) No �L New Construction: Yes ❑ No X FHA/VA: Yes ❑ NoK TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `�,, Ir Septic Tank: Distance from nearest welL /��Distance from foundption_/4. .....Materia ee� .t�.____ No. of compartments__ _``._FF_._.._...._.Size__ ._ .X.S. Liquid depth_._._5...Z ��__ Capacity-Si Dis osal Field: Distance from nearest well/W-67"Distance from foundation_ ._ p ,�_Q.. .___.Distance to nearest lot line.._._..... Y�ai{ Number of lines Cf._ -----Length of each line_- �Q_.__. .. . _. Width of trench.__ _._. �� Type of filter material _ Depth of filter material---- length...._-_..x_Q_Q_----------------- Seepage Pit: Distance to nearest well_A).01% .-Distance m f ndation_,_e_.__._._.Dista�ce to nearest lot line-.�._----_ Number of pits..Q1�LCCL�_Lining material--- Size: Diameter-3--- -------_.Depth--7—,s- v Cesspool: Distance from nearest well ________________Distance from foundation------.---_...... ..Lining material----.-.--__._.----..._---_.----_-_-_-. ❑ Size: Diameter- -- ---------- -- ----------------Depth---------------------------w--------------------- Liquid Capacity-_-------------------------gals. Privy: Distance from nearest well_----_-_-__ --_._.-_.____-._-__..___._._Distance from nearest building-_---------------_---_--._...-_...__.--. ❑ Distance to nearest lot line-.------- ----- ------------------------------------•-•-•----------------------------------•--------------------------------------- Remodeling and/or repairing (describe): --- - --'� --------•---------------•----- ----------------------------------------------- ------------------------------- -----------------------------------------------------•----••-----------------------------------------•-------•-----------------------•--------•-------------------------------------- I hereby certify that ae prepared this application and that the work will b done in accordance with San Joaquin County ordinances, State laws, nd i es and regulations the San Joa i Local Hea District. (Signed) - - --------.- . ------ - ------------ --------- ---------- -- ----(Owner and/or Contractor) By:--------------------- - -- - (Title) --- - - -- (Plot plan, showing size of I , location of syste in relation to wells, bulldings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---------------------- -- --- ------- --- -- ------------------------------------- DATE------- REVIEWED - ---REVIEWED BY------------------------------------------ ------------------------------------------------------W--------------------------- DATE_--------------------------- BUILDINGPERMIT ISSUED---------- --------------------------------------------------------- ------ DATE------------------------------------------- Alterations and/or recommendations------- --------- ---- --------------------- --------------------------,----- ----------------------------------------------------------------- ------ -_-----------W--- --------------------------------- ----------------- -- ------------------------------------------------ ------ ----- ------ ----------- -----W------------------------------------------. ----------------- -----------------------------------------------------------------------------------------------------------------------------------------------------•----------- ---........----------------------- r T ,- FINAL INSPECTION BY:.`� ' '".............. ,'�t - Date.-....-. O �^ 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