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FOR OFFICE USE: ............. APPLICATION FOR SANITATION PERMIT Permitd�'No.'. j�� . (Complete-in Duplicate) Date Issued --�--�-/U-�� ------------------ ----- --------------------- 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 No. 549 JOB ADDRESS AND OCATION /_ (�.- - G -----? G Owner's Name -,4 - .� ---------- --- -- -------- ------------ Phone.4 -�-�----------f Address----------------- Zs� ----- �J --• - •- ! r Contractor's Name - • :. /-l1).tiE. Phone-- (ai f -- - --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms -_Number of baths I.-.- Lot size 1117. --.-x-..IZ..$7-------------------- � Water Supply: Public system X Community system ❑ Private Depth to Water Table7.9'ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay W AdcbeX Hardpan ❑ Previous Application Made: (If yes,date.- -------- -: ) No V New Construction: Yes ❑ No �. FHA/VA: Yes ❑ No X 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 ------------------------..--------.------------- ❑f=j(t54i0C No. of compartments--------°---- --- -- ---Size------------------ -----------Liquid depth--------- ------- --------Capacity----- ---- Disposal Field: Distance from nearest well.-.-.----„------Distance from foundation--------------------Distance to nearest lot line---------------- ❑&(S4 {J6-Number of lines----------------------------------Length of each line-- --------------------------.Width of frenck------------------------------------ Type of filter material.----------------------Depth of filter material---- ------------Total length-----�-----------------/--..--_-.---.-.-- Seepage Pit: Distance to nearest well-A&W-_AS:7--Distance om undation.. 1_ -.....-..Distance to nearest lot lin .-ate.......... Number of pits... I...............Lining material_ ... Size: Diameter�,�•.--1lt - Depth-.ZS.-•----....--_....... Cesspool: Distance from nearest well ................Distance from foundation--------- ------- -Lining material......---.---------_.---_---------- i ❑ 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): v --- - --------------------------- ------------------ -- -------------------------------------------- s • ------------------ --------------------------------------------- --- ------44—-------------------- --- ------------- -- - --------------- ----------------- --------------------------------------------------------- --------------------------------------- I hereby certify that I have pr are this application and that the rk will be done in accordance with San Joaquin County ordinances, State laws, and rules nd r gulations of t San Joaquin L w I Health District. JV (Signed)------------------------------- ---- -- ---- / ---- - - - - ----------.------.(Owner an r Contr ctor) By:------------------- aL.X �It L� '" - -- -----(Title)------ (Plot plan, showing size of lot, ocation of system in relation t wells, buildings, can be place on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----------------- ' - --- ---------------------- ------ DATE------- ->----------------- REVIEWEDBY------------------------------------------------------------------- - - --- ---------- - ------------- ----------------------- DATE----- - ------------------- BUILDING PERMIT ISSUED-------- -- -- ----------- - DATE - Alterations and/or recommendations:. ®�--------� -- --- l --------------------- ------ ---------------------------- ----------- ------ -------------------------- -------------- ------------------------------------------------------ ------------------------------ ---------------•-------------------- ------------------------------------- ---------- - ------------ ------------------------------------- -----------------•------------------- -- ------------------------------------------------------ --------------- --------------------------- -------- F€NAL INSPECTION BY:.----- _-- ---------- Date------. ----�- � `-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasdton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,Californiaf Tracy,California E.H.9 2M 1-67 Vanguard Press — xot d