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1-UK UFFICE USE: ;— ------ ---------- -------------------- ---------- APPLICATION FOR--SANITATION PERMIT Permit No. ----------- ------------- ----------------- ----- -- (Complete-in Duplicate) --- -- ----- - ----- ---- ------------ --- --------- This Permit Expires I 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 LnO�CATI+O' - --- -AW.Y, --- -- Q Owner's Name +-�f r L ' .t'i.- .R-� A- - Phon �•� --------- ------------------ - --- --------- ----- Address C� ... IV1� .- ------ QS;t?/� ` S4 711 �t��• ---------..-•--- Contractor's Narrie-------------- -- AR-PILS.9------- -� --- 4&d.� t� - ---------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Motel ❑ Other ❑ ❑ Trailer Courfi Number of living - units: ----- Number of bedrooms ._�.- Number of baths.-/.---- Lot size --,7-��..- Water Supply: Public system ❑ Community system [] Private X Depth to Water Table X5_7 ft Character of soil to a depth of 3 feet- Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0� Hardpan [] W Previous Application Made: (If yes,date------_ . ---- ) No sw Construction: Yes ❑ No f /VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weil-------- ------Distance from foundation......_............ Material _----...---__..--.-....-_ -------- ❑�XLS /11>y No. of compartments---------- ---- ------ Size---------- ------ - --- -----.Liquid depth_----- -- -- -- ------ Capacity--- " - ------------------ DTs s I Field: Distance from nearest well... -------------Distance from foundation----------- ---._.Distance to nearest lot line------- Number of lines.7--------------------------------Length of each line_- -----------------------Width of trench---------- ' --------------- -------- Type of filter material-------------------------Depth of filter material------------------ .Total length-----.---��d-- -- r � - -------------------- Seepage Pit: Distance to nearest we�--�Q-a--------Distance rom ---- Distance to nearest loft line--CQ------- Number of p�ts� ----I- material-----.._- // _Lining I---- Size: Diameter.- �'_. Depth- ..�'._. p � /-Z- �- Gesspool: Distance from nearest well ----------------Distance from foundation---.---------- Lining material - s. , Y: Distance from nearest well---------------------------_-- -.------ --Distance from nearest building g ------- --- ❑ Distance to nearest lot line ------------ --------------------------------- ------------------ Remodeling and/or repairing (describe):---_ -.-_ I ----------------------------------- . _. - - - - ---- --- --- ----------------------- -=------------------------ ------------- ----------- -------- -------------------------- ------- --------------- - =----•--------------- '------------------------------ ------------------------------------------------------°----- I hereby certify tha have prepared this application and that the walk will be done in accordance with San Joaquin County , ordinances, State laws, and rules and 'regul ions of the Sart quin Local Health District. (Signed) - - - _ w r....... ----- -' - -- (Owner and/or Contractor ---- BY=------------------------------ (Title) G-C (Plof plan. showing size of lot, location'of system in rel ion to wells, buildings, etc., can be plaidn reverse side). 2 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----- - -- -- - - � ,,� ----- ------------- - - -------------- ------ --- ------- --- DATE--------j S ---------------------------- BREVIEWED BY -- ---- --------- ----------------- --------------- - -------------------------- UILQING PERMIT ISSUED-------. - .--------------------------- - 1 r DATE -- --------------------- ------------------------ Alterations and/or r commen tions:-- -- _.. / � _ 4' . � ---- --- - ---- ---d -- -��.��------- pil- -------------------------------- -ern - d ----- .-- --H --�- rr. / Q >� f....................T-------- -------------------------------------------------------------------- ----- -------- ------- ------------------------------=------------------- FINAL INSPECTION BY:..-- �-- ------- ---------- -- ------ Date. --- .f�r -� w --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 Wes!Oak Street 124 Sycamore Street 205 Wes!9!h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2N4 1.67 Vanguard Press