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FOR C "-ICE USE: U p �/ r -----.---_ __ ..--. _ APPLICATION FOR -SANITATION PERMIT �' Permit No. -` - � ------------ ------- - ------------------------- --- --------- (Complete-in Duplicate) ` �#�- � • Date Issued ..-.--.._.-..-._.-.. --- --- .._--.--- 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 Co ntty Ordinance No. 549. JOB ADDRESS AND LO ATION f p _ffj_1� ---� A .. 1�1 . Owner's Name.-__i---H9f-X' -- -------- ---- /j Phone----------------------- .rk.3 7--- r - ----------------------------- - --- 0,11y, Address.- = Contractor's Name------------- - -------.- ------- -- - ----- ----------------- :.T--• ------------------------------ Phone------....... -------------------_ ----- --- - - Installation will serve: Residence•[') Apartment House-E] -Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1.-_ Number of bedrooms -3... Number of baths_2-_ Lot size ----- --- ----------------- -------------------------------- Water Supply: ,Public system ❑ Community system ❑ ,Private [n- Depth to Water Table7:- - ft t I- { Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loa ❑y Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ^�� Previous Application Made: (If yes,date-------------_--- ) No ❑ New Construction: Yes—E] No ❑ FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: b (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '" Septic ank: Distance from nearest well-_15(v........Distance from foundation-,.-JO-1---- ...C-o iLo. ---------------- No. of compartments_..r,.:.?--._.------.------Size'Vle__ . quid depth----fes ..... ........Capacity... _--. Disposal Field: Distance from nearest well-- .5v' Distance from foundation---/a-`�----...Distance to nearest lot lines --.---.---' Number of lines __-_----_ _-.___-p-.___-_Length of each line__ 7 �---------------Width of trench---------------------- ------- ----.---.-__----_____------- Type of filter material------ 'Jt_-._-___Depth of filter material----,�-y'`_�---_----Total length----.� t'_--..__-_ i Seee Pit: Distance to nearest well...f0?!-..----..Distance from foundation--- -----------Distance�to nearest lot line-.--S-----.--;� Number of pits.-- ---�------_.Lining material--.-_S-!e.----- Size: Diameter-----3 _--..---_ Depth ---------- Cesspool: Distance from nearest well ----------------Distance from foundation-_-__-"'_--..:---..Lining material---------- ----------..--..--.--.--. I ❑ Size: Diameter- -- --------- ----- - --------------Depth---------------------------------- ------ ----------Liquid Capacity-------------- -------------gals. Priv Distance from nearest well. _Distance from nearest buiidin ` Y' ❑ Distance to nearest lot line------------------------------ ---------------------------------------------------------------------------------- -...._ -- Remodeling and/or repairing (clescribe�--------------- -- ---- --------- - ------------------•-•--------- -------------- ---------...------------------ ---------------------------- - N --- -------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ------- ---------------------•--------------------- ----------------------------------------------------------------------------------------- ----------- ------------- ----------------•-------------i------------------ ---------- -------------° -- --- -- ----------------------------------------------•--------•---------•---•-------------- -------------------------------------------------- ----------------- ------ ` I hereby ce tify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Countyc\� ordinances, St to laws, and rules and ons of the San Joaquin Local Health District. (Signed) - ---`---- ---------- --- -.�{9wser and/or Contractor) ---- By::- -- ---- - ----- - (Title - (Plot plan, showing size of lot, location of syst m in relat n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._.- ----------- ------- --- ---- DATE / �. REVIEWEDBY----------------------------------- ------ ............. ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- - ------------------------------------------------•---------------------------------------- DATE--------------------------------- ---- Alterations and/or recommendations:-------------------- - ------ - - --------- ----------------------------------------------------------------- ------------•----------------•---------- FINAL INSPECTION *g• � Date-- =---�' --6--7 -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Ladi. California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press