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i FvR ,jrrrt.t USt: - .................__ _ APPLICATION FOR SANITATION PERMIT Permit No. -p� �3 (Complefe•in Duplicate) -------' ----------------------- --- This Permit Ex 'res 1 Year From Date Issued Date Issued _fl�_--//�-- Application is hereby made to the San Joaquin Local Health District for a permit t.0-constructsnd instal! the work herein described. This application is made in compliance with County Ordinance No. 549. l /l :. JOB ADDRESS A I' CA TIO=NS _--�+ZV Owner -------4------------------- --- Name_ zsv --•---•----- -Address......... ` Phone------------------------------------ Name_-- ------------------------------- - ------------ Contractor's -__. .---_ - - - - -- ----------------- ------ ...........--- - ----- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court _ E] Motel El Other E3Number of living units: �_-. Number of bedrooms-3-- Number of baths__�Lof size ----- ___ - - Water Supply: Public ppY� system ElCommunity system ❑ Private Depth to Wa#er Table'--�'"'{}- -_s.-- m Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [°� Previous Application Made: (If yes,date................... I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Eq (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Tank:� Distance from nearest well__./ ---___Distance from foundation_.._la-- ---,-.Material No. of compartments----- `-- Size �b r .-- ...: -_!t -- --d'j'------Liquid dept----- `.._-.-- ----- Capacity-j ao . - jF._ k Dispos�Field: Distance frorrl nearest well-.o�f�_-_---_Distance from foundation_---` - ----- -------Distance line 1 el ----------------- of trench.-�__`-__-____ Type of filter material-------- w--_Depth.,of-filter-material___If"-. --------- 3 Total length moo------------------------ _ Seeps a Pit: Distance to nearest well. ._._ Qo --_Distance from foundation----- to nearest lot line._-5-- Number of pits I___Y__.--Lining material-__-_-.S',-2._-- Diameter._--- --- __.-`' i - Depth- -7-- Size. --------------------------- -Cesspool.- N ❑ Siza:,,Diameter_ -- Distance from foundation................. :..Lining material.__..__-_- Depth------------- --------- -------..._Liquid Capacity-------- .�. istance from nearest weli _____________ __n Privp Y gals. x- Y• Distance from nearest well_-___..._.._..-__-_ _._ ---------Distance from nearest building ' ❑ Distance to nearest lot line -----------------• `- -------� -------- ---------- --------- --� ------- ------------------ Remodeling and/or repairing (describe):--- ------------- ------- y f -------- --------------------------------- ---------------------- I ------- --------------- ------ - __=' ------- - - --- ----- ------ - - - ----- I hereby certify that I have prepared this application'and thafi the work will be done in accordance with San Joaquin County ordinances, State law , and rules and regulations of the San Joaquin Local Health District. (Signed)---------•--- ---- --------------- ---------------- --- --------------- � >wirter a t and/or Contractor) (Title)-,-.. ... (Plot plan,'showing size of lot, location of system n relation' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE E ONLY , APPLICATION ACCEPTED BY-.-'. - REVIEWED BY. - ------------ --------- ---- ----------- DATE__...- - -----� -------- -�- ---- -�----�- ----------------------------- -------- ----�- BUILDING PERMIT ISSUED-------- -- ------- -------------------- ....................................... --------------------- DATE_._. ............................................. Aterations and/or recommendations:._..)................. ----- ------------- - ------------ ----------_ ------------------------ FINAL INSPECTION BY: / 0 ., 011 ----------- ------------------------------------------ Date.... .......... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California 205-West 9th Street 1 Lodi. California Manteca,California E.H.9 2M 1-67 Vanguard Press ( Tracy, California