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FOR OFFICE-USE: _................--- -------------.--------------- APPLICATION FOR-SANITATION PERMIT Permit No. .._.._......`.._-___.._ ----------------- "------------- --------- (Complefe•in Duplicate) .- This Permit Expires 1 Year From Date Issued Date Issued _ =___�7__ � 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 LOCATION--- - - 3 /_. ---�----*- ----------401*0--- Owner's Name--- -- � ------- .]_I_ . rte.... --------------------- Phone d . Address -- -. _--- -------------------------------------- - ------------ ------------------------------ Contractor's Name Phon jF�, _.._ Installation will serve: Residen e X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ 7 _ Number of baths__!____ Lot size _ ___Z ..�a2C _�__..__.__ Water Supply: Public system "F-0 Community system ❑ Private ❑ Depth to Water Table _7s ft + Character of soil to a depth of 3 feet- Sand [❑ Gravel [] Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date............_ ---- ) No$4 New Construction: Yes ❑ No X FHA/VA: Yes ❑ No,K 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 ----______.._..__.._____.__.__._..___-.___..._. ❑&5,4sNG No. of compartments------------------------Size---------------- --- -----------Liquid depth ------ --- ------- Capacity------ ---------------- Disposal Field: Distance from nearest well_LVBN2-_Distance from foundation-AC- ---------Distance to nearest lot line---2Q_...__. Number of lines f-� Length of each line__ __ C g '�� ---- T Width of trenchw a dr -------------- l,\j Type of filter material._..1 ---_.--Depth of filter material_ J..............Total length------- --------------------------- Seepage ______.___-_-__________- See a e Pit: Distance to nearest well_ rl/� /Q . \ p g ��,�1 --Distance om undation-_-d4 r!<l___-__Distance to nearest I t line-__ -______.._ Number of pits___CJ)----------Lining material.„- Size: Diameter...3.3.fr._____.Depth_.��_ __-------_______ Cesspool: Distance from nearest well ________________Distance from foundation...-------------- ..Lining material__._..__.._._...___-._.---___________ ❑ Size: Diameter_ __ _________ __ - - -------------- Depth---- ------- -- --------------- - --Liqvid Capacity- • ------------ -------..gals. Privy: Distance from nearest well----------------------------------------- Distance from nearest building----------------------------------------. ❑ Distance to nearest lot line ... - - ----------------------------- - r p Remodeling and/or repairing (describe]:---- Z - - --------------- - ---------- - -- ---- ---- ---------- --------------------------- -------------- ---- ----------------------------------------------------------------------------------•--------------------------- -------------------------------------------------------------------------------------------------. 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State iaw an rules and r lations of the S Joaquin Local Health District. (Signed) = 7,.n ------- .-- (Owner and/or Contracfor} By:------------------- ........ `--- --- --------- -----(Title} (Plot plan, showing size of lot, location of system in reto wells, buildings, etc., can be placedn reverse side}. ^,4 ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED _ - ---------------- ---------- DATE-- -7�' G REVIEWED BY----- -------------------------------------- --------- --- BUILDING -BUILDING PERMIT ISSUED-------- - ---------------------- --- ------------------------------- ------- --------------------- DATE------------------------------- ----------------------- Alterations and/or recommendations:------- -------- - -- - ------ -- T-h1--5-------i-- ._.jV d o P a s- - ---- FINAL INSPECTIONBY: -`----�V ----- --- Date--------__--------f-- ..... 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.92M 1-67 Vanguard press