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FOR OFFICE USE: ----------- ----------- ......----------• �y APPLICATION FOR SANITATION PERMIT Permit•No. ..(P_. :. 47 ------------------------------- ---- ------------------- (Complete-in Duplicate) bate 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 County Ordinance No. 549. -'--OJOB ADDRESS AND LOCATION-------- -------- - - s" ----"-f?-----------?7_-------- - ---- -------- ,._=--------------- Owner's wners Name-=---------_--------------------- ---. Phone------------•-- Address............... -------- :� -- ""`y� - ---- -----------------=--------------------------------------- ---------------------------------- Arid Contractor's—N me:" '_4------.------- ---------------- ----•- ------ --------------------------- Phone. Installation will serve: Residence Apartment House ❑—Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ._ Number of bedrooms --A- ,-Number of baths _ _. Lot size __.__ ::� '`• Water Supply: Public system ❑ Community system [] aPrivate pth to Water Table t '� Character of sail to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ �. e Previous Application Made: (If yes,date----------- ------- ) No Ej+ie New Construction: Yes ❑ No FHA/VA: Yes-❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well__.,.__ :_ .__ Distance from foundation___--- ._,6_ Material ------:.tl__ X " apa ---------- No. cifiY- of compartments-..-- ......................:...Liquid depth--------- --- 0110 5+; #- Disposal Field: Distance from nearest well ,E"' Distance from foundation Distance to nearest lot lms___.. Number of lines -- Length of each line-_ _._ 4rWidth�of french I. Q . � . Type of filter material_' Depth of filter material-- __�"'- -Total length-----$ -_-__----_.-__. Seepage Pit: Distance to nearest wells/ {: Distance from foundation___ 'F�__.Disfance to nearest lot'line--._-- Number of its___ ._._., -_ Lini material__ / i "ize: Diam ter._ Depth-_ p g '! - p #;l'"� Cesspool: Distance from nearest well ----------------Distance from foundation..-::----------- _.Lining,material-.-......-_.---.-_--.-.-_---__-------. ❑ Size: Diamefer- -- -------------- ---------------Depth------ -------- ----------- - - -----Liquid�Capacity----= _ 9 f als. Privy: Distance from nearest well..........................._---_.__-...____._-Distance from nearest building-----.-------------------------------------- Distance _- __-._-___.-. ❑ Distance to nearest lot line---- --- ----- - ----------------------------- -- - -- ---------- ;� ,�-- Remodeling and/or repairing (describe}:..... F --------------------------------. _ - �.. 1 67 ------------------------------------;-------------------------- -------- -------- ----- - -------- -------- -------- ------------------- ------ -- ---- •------- -- -- r ---------- -------------------------- --------------------------------------------------- --------------- ----------------------------------------------- -------------------------•----.------------- - -- --- -- - - t 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, and rules and regulations of the San Joaquin Local Health District. (Signed)- x A -- ------` =` i = (Owner and/or Contractor) By--------------------------------- ---------------- ----------------------- ---------------------=----------------- =" =lrtle}---------------- - --------------------------- -------------- (Plot plan, showing size of ]at, location of system in relation to wells, 6uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f } DATE lrf�111�---------------- - REVIEWEDBY-------------------------- -------- ------------------------------ DATE----- ----------------------------------------------------- BUILDING PERMIT ISSUED-------- -- -- -------------------------------------------•------------------- ------ DATE---------- -------------- - Alterations and/or recommendations:-------------- -- ----- -_--------------- --- ------------------------------------------------- ---------- ;---------------------------------------------- i ry ---------------__.__.--_�------------_-------____.__.____.___.___-...---____..._..__._.___.____..__.._.__.---------------------------------- ------ .------------------.__-_-_--------------------------- . zk Q ItdA EL INSPECTION BY:_._, . . .�_... !/ 11 Dat. .:.......... .3 A, / r _ f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxelton Ave. 300 West Oak Street 724 SycamoraiiStreet 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press +v