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FOR OFFICE USE: ----------------,.-_-,----_,....---------- ------------ APPLICATION-FOR SANITATION PERMIT Permit No. -- --- (6o plete-in Duplicate) I ......... This Permit 'Ex'ires 1 Year From Date Issues! 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 LO TI CJ!��': -. ✓�:_- - // �SP�`T�, --- ------ - y Owner's Name--- Address ame •CSL .-?= I� i � ti -------------- Phone------------------------------------ Address------•CCS /off------ = -------_---------------- - -----------------------.--- --------------- --------------------------- --D •-•--------------------•--- Contractor's Name-�,/�--A ! �� :`' : ` ------ Phone-ea ---y-'�'�__!----- � .y �.►-r.,.�. �+ar:tom.. Installation will serve: Residence R Apartment House'❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: __/__-_ Number of bedrooms � - . Number of baths--- --- Lot size -- -. ��- -X- --I --------------------- J Water Supply: ,Public_system❑ Co�mmunitylsystem ❑ Private,[ . Depth to Water Table ft Character of soil to a depth of 3 fest Sand ❑ Gravel ❑ Sandy ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan E] Previous Application Made: (If yes date.:-_:�._�._-- ) No ® New Construction: Yes ❑ No FHA/VA: Yes ❑ No 91 tl r TYPE OF INSTALLATION AND,SPEC I FICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 200 feet_.) ]! Septic Tank: Distance _ _ from nearest well-..--- _ _----_Distance from foundation_..____ �`- _.Material ------------*:_�_--------------_'------------- ❑ No..of compartments_. --- ..................Size-------------------- -----------Liquid depth . ----. --------Capacity---------- ------------ Disposal Field: Distance from nearest well_'--I--0 -_Distance from foundation____40_ -_.-..Distance to nearest lot line---=3'`-._____ Number of lines ---------4_..�.�'- ---_--.----Length of each line-- ----------------- ofarench.....,�-4�_ ----------------- /`,``fix F � V t Type of filter material-------- of filter material----- length_.-.___ �_'"____________4------------ Seepage __-___-._ ' - .._._� r _.rte . `:F <-- See a e Pit: Distance to nearest well /4 --- ---Distance from foundation___ p g _a__.___.-__.Distance to: nearest lot line___.•-____-._ ® Number of pits... ___} -----------Lining material______ 6_t'l - Size: Diameter_ ^____..... Depth--._--2,�---_______________ Cesspool: e Distance from nearest well ----------------Distance from foundation__-_............ ..Lining m9 "al_---___.---_----___--__-'____--..___. ❑ Size: Diameter. -_ -______ -Depth------____ __ ----___-_-Li uid C ctitgals. Privy: Distance from nearest well------ -------i-.-.-__.-___--.---.-.____--_-_Distance from nearest build'tn ____:_-____--______---_. ❑ Distance to nearest lot line .- f ------------ --------------------- - - € - ,, /� Remodeling and/or repairing (describe): f.�: _ 4-"�;. ----- ---- --- --- -- -- --•---�-- ------- ----- t # �'� - - --- --------------------- - ____________________________i___________________________________.---------------------------------_---------------------------------------------------------------------y--____---________________-___-___-____---t__ __-___---_ -- - ----------------------------------------i-------- I hereby certify that I 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) .- � _ .. Owner and/or Contractor) Y � ------ --------------------------------------(Title) = -- ------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - AGO_ DATE - -- _ , ---------------------------- REVIEWEDBY ---- -_------ ------------- - ------------- ---------------------------------•--- DATE----------------------------- ' BUILDINGPERMIT ISSUED---------- ------------------------------------ -------- -------------------------------------------- DATE- ---------------------------------------------- Alterations and/or recommendations:--------- - --- ---- ---------------------- ---- ----------- --------------------------------•---•------------- r--- �---- ------------ ------------------------------------- ---------------------- - ------------------------ ---------------------- ----- -`---- ---- -`------------------'----------=-----•----------------------------------- - ---------- --------------------------- x: ------- -------------------- ----- ------------------------ ---- --------- - --------- ------------- ------------1116�-- ------�-�------- ---------------------- ----- ------------------------------ ................... j la FINAL INSPECTION BY Date-----.'-_//-_C--�. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 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