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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _.��_ ��._`_2._. - - -------- (Complefe•in Duplicate) Q1 -_ - ------ - --- --- ----- This permit Expires 1 Year From Date Issued 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 com lianc with County Ordinance No. 549. 23 S arJO' .. JOB ADDRESS A D LOCATION-- ----a�7 I� � ----------------------------------------------- Z�� ------------ { �J' -l ` - ---------------------------- Phone--V� __.�75 Owner s Name L� / .Q - Address_ CAW,•ee!g....�j _�.. f ,..... �/ Contractors Name ../�.-f/�__Z. Z-- � ------------------- ------- --- -------------- ---------- Phone_�la��dr�----- Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms -------- Number of baths----..-_ Lot size __ ------_-------_________________- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Tabie --- ft Character of soll to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ ; Previous Application Made: (If yes,date-------- ------ -- ) No New Construction: Yes ❑ No �R FHA/VA: Yes ❑ No f 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 ------------------------------------------------ El ----____-_-_ _______-__--_____-_-.❑ No. of compartments-------------- -.----Size---_-•-------:------ -----------Liquid de th------- ........Capacity Dis osal Field: Distance from nearest well--------------Distance from foundation___-147..........Distance to nearest lot line____ _010____. I ® Number of lines.--------1-----------------------Length of each line__ -_-,319 ---------.Width of trench---- y`i------ ----------- tt. Type of filter materlalL0eJ<........Depth of filter material..../ -_-.......Total length__ ,34______.__ _____________ _ _- (� Seepage Pit: Distance to nearest well...�--------------Distance from foundation---tlBF_----___.Distance to nearest lot line--------do _ l --Linin material_-_X6�!-_--. Size: Diameter__-_1V_tV'-..._. Number of pits---�---------- - g -----Depth-----��'------------------- 3 Cesspool: Distance from nearest well ----------------Distance from foundation..-.------------- -.Lining material----- ---------------------.---------- 171 --_____.❑ Size: Diameter- -- ---- -------- ----------------Depth--------------------- -------- ---------------------Liquid Capacity----------------------------gals. i r Privy: Distance from nearest well................---------.-------- .---_.- ._Distance from nearest building--------________-_-__._-__._- Distance to nearest lot line------------------- - ---------------------------------------------- - Remodeling and/or repairing {describe;-_-_(/ ��e v__._ ".C' - --- - �--•--•-------- ----- =-¢ �_. � - v� ------- - ri- -= , o ------------------------------------- ---------------- ----- ---------------------- --------- -------------------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------- ------------- 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,A rules and regulations of the San Joaquin Local Health District. (Owner (Signed) -x!---- .-.. - (O and/or Contractor) l —------------------ tTitle)-- a (Plot plan, showing size of lot, location of system in relation to wells,w_buildings, etc., can be placed on reverse side). _ , FOR DEPARTMENT USE ONLY x APPLICATION ACCEPTED SY._._-__.-._. - ----------- DATE-_. � -------- - - - --------- ---- REVIEWEDBY---- -------------------- ---------------------- --------------------------- --------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- -- -------------------- ----------------------- ---- ------ ------------------------------ DA-TE.-.--------------------------------- .------------------ Alterationsand/or recommendations:------------- ---------- ------------------ --- ----------------------------------------------------------------------------------- --- ----------------- ------------------------------------------------------------ ----------- ----------------- --- ----------------------------------------- ----------------•- ------ ------------------------- -- -------------------------- - FINAL INSPECTION BY:---- ---------- Date---------- `2 `G ------------- -----------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 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 r I �'