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rUK Ut-H(_t: USE: ----------� --------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. 4'P 2,3.,?-' - ---- ----- - ------------- --------------- ----- .-- (Complete•in Duplicate) ------------- This Permit Ex fres 1 Year From Date Issued ------------ Date issued --_/ Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. i JOB ADDRESS AND ATION_.__ V__ C ----------- --------------------------Owner s Name------- Ke ---------- -------------------- --- i . ------ -:-- -- -- - Address . Contractor's Nam -- --- - tPhon_ --- Installation will serve: Residence Apartment House ❑ -Commercial j❑ Trailer Court ❑ Motel its: � El Other ElNumber of living un �.---- Number of bedrooms Number offbaths._�_____ Lot size _ � c Water Supply: Public stem .X--_Zp� Y ❑ Community system ❑.. Private X Depth to Water Table ft Character of soil to a depth of'3 feet- Sand ❑ Gravel ❑ Sandy Loam.0 Clay Loam Previous Application Made: (If yes dClay El Adobe❑ Hardpan ❑ I ote___..____ . _..__ I No� New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: R FHA/VA: Yes [I No � v (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' Septic Tank:`` Distance from nearest well-_--_____._-....Distance from foundation_..__F. ' ❑64S4N(5 No. of compartments. Ma- ---- ------------------------------------------------ . _ . ------- .- ----Size-------------------- -- -- -----Liquid depth--------- ---.- ........CapacifiY-------------- -------• Disposal Field: Distance from nearest well &47' _Distance from foundation./Q_- Distance to nearest lot--ne_. o ��qq Number af'lines.- e �_-�". J"l .-:--. ft------...-_Length of each line__ -�.--- Type of filter materia!__-__ ------ --------- Width of trench.._ -_.---_ Depth of filter material_-_.1__ �� Total length- 7_ - ----------- Seepage Pit: Distance to nearest well from foundation-------------------Distance to nearest lot line--.______--_____ ❑ Number of prfs--- ------------------Lining material------------------ Size: Diameter------ -------- ----.Depth---------- ----------- Cesspool: Distance .from nearest well --------- ------ ----�- - El Distance from foundation_-.._____.,,.... Lining material_._._-_-__________________ S ze: Diameter_ _- --------.- es -- Depth------------- ---- .Liquid Capacity-------- ------- ----- ------------- gals. Privy: Distance from nearest well -_ -----_- ......................Distance from nearest buildin ❑ Distance to nearest lac Gne_._ g-------� --------------------------- --� ------- ------ Remodeling and/or repairing (describe):__-- ------- .- - -��------ -------------- -- --- - - --------------------------- ---------------------------------------------------------------------------------------------------------------------- I hereby certify that ave repared this application d that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules nd reg tions of the S Joaquin Local Health District. (Signed)-------------------------- --- ------ ------ --•--------------- ---- (Owner and/or Contractor) Plot lan, showing sizer 1 {Title)---__--- - 8 ---------------------------- (Title,--.- of g of lot, location of system in relation to wells, buildings, .".,etc., can be place n rse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_._ ------------- --------------- DATE._ '6g REVIEWED BY -'.� . ---- _. ............. ----------------------------------------------------- - DATE---- UILDING PERMIT ISSUED---- --- ---------------- +. � ---------------------------------------•------. ----- ----------------------- ----.-- ---------------------------- DATE----------------------------------- Alterations and/or recommendations:.-----.--------- ------ - ------- -- ---------•-.--- -------------------------------- ----------------------------- ---- ----------- -- O � FINAL INSPECTION BY:.---_ ----------- ---------- Date...... 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 E.H,92M 1-67 Vanguard Press Tracy,California