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FOR OFFICE USE: �- - -C---�P- 1�r- -------- - -------- �-- ---rte- � ��' Y �� / J �� APPLICATION FOR .SANITATION PERMIT Permit No. _e?..._f_..._........... ------------------ - --- --- ------------ ------------- - ----- --------------------------...---- -- (Complete in Duplicate) .. 6_�I, 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONd -------------------- --- Owner's Name----- ��Y!/11'--6_--•----fzl-...._ l C'!t'_ ---- - --- --------------- Phone ` lam X7 l Address-_ � tt` i°��el � �' ....... Contractor's Name------ / - = f------ --- ---•---------------------- ------- --------------------------------- Phone----•- --------------....- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ // Number of living units: -- ----- Number of bedrooms � �- Number of baths-1_._ Lot size __° -- '-f- -.____------------------- Water Supply: Public system `_Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe kHardpan ❑ 1 Previous Application Made: {If yes,date-......... --_- l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ h y TYPE OF INSTALLATION AND SPECIFICATIONS: i V' (No septic tank or cesspool permitted if public sewer is available within 10 feet.) ! w Septic'Tank:,.. Distance from nearest well----___-_______-Distance from foundation___--. ------Material ------------------------------------------------ .t`a 7 7,is P Liquid dep ----hN '----- ........Capacity.-__ R--- --- No. of compartments Size Disposa i Id: Distance from nearest well_--.. -..Distance from foundation.-Ze--_-----.Distance to nearest lot line__----_-_-- Number of lines ------ -------- Length of each line------- O Width of trench..._ .'--------.----------_-- Type of fiter material-_;Bx,'d'/Z,___Depth of filter material_______-,9D__J,"-Total length-------- _e --------_--__--.-----_ i Seepage Pit: Distance to nearest well............... ------Distance from foundation-------------------'Distance to nearest lot line-------.--------_ ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter____-------------------Depfln--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation ....... Lining material--.-._.-.-.--_-._-_.-__--_-_---------. ❑ Size: Diameter- -- --------- ----- ----------------Depth--------- ----- ----------------------------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well_---__--------- ----------------------------Distance from nearest building.--.------.---.---------------.--.-.-__ ❑ Distance to nearest lot line ----------------------- ;-_x ---------- Remodeling and/or repairing (describe:.-./-1 � ... .. .Kf-S►T J --------_Kss ---------------------------------------------- -------------------------•--------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- - ----------------- ------- ------------------------------------------------------------------------------------------------------- ---------------------- --------------------------------------------------------- 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. {Signe ! .:.L-- -------- --- - - --- (Owner and/or Contractor) �Sy..-.-.----•---------------------- -------•--------------------------- ----------------- --- -- (Title) - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -/ ------ ---------------- -------------------- -------- --------- DATE.- � -��— t{ - ------•- --------------- - REVIEWED BY----------------------------------- --- ------ ---------- -------------------- --------- ------ ------ DATE------------- ----- - - - ---------------------------- BUILDING PERMIT ISSUED-------- -- ----- ---- ------ ------ DATE--------- --------------------- --- -------------------- Alterationsand/or recommendatio s:--------------- ........... -------------- - - ---- ----------- --------------------- ------------------------------ --------•----•--------------------------- FINAL INSPECTION BY---------- ---�.. __- -.- -�� ------ ----------- Date-- ------ ---- - ------ ----------------------- S ----- -------.-..-----S '(/N J UIN LOCAL HEALTH DISTRICT 1601 E.Naxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California -� Manteca,California Tracy,California E.N.9 2M 1.67 Vanguard Press