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FOR OFFICE USE: --------------------------------- -------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. --•--------------- - -------:----- ------------------------------ - (Complete-in Duplicate __ 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 theL`w ork heren described. This application is made in compliance with County Ordinance No. 549. J08 ADDRI_SS AND LOCATION-� - - - �-'�'�`� -��---�''^'------. .."'-'�"-'d><�--------- ---- -----•-•----- -_---- Owner's Name--. fir!'r ---•------------------ ------ -- Phone_-----------•----------- -- - •---- �+ q� a Address .,5 --.- y `��` ht- d5..--Irl---- --- - -• •- ,-� ---- ---rte C ---------- Contractor's Name---------&.As f V -- -- - �3r Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: --I---- Number of bedrooms Number f baths-? Lot size ----- __ _----.-_---------------- Wafer Supply: Public system E] Community system ❑ Private ['J Depth to Water Table ...... . ft Character of soil to a depth of 3 feet- Sand Q Gravel ❑ Sandy Loam E!( Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,dote-______________'_-. ) No ❑ 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.) Septic ank: Distance from nearest well----- a-�.--Distance from foundation__--j.-Q- ---Material ...to-p ...... _.--___-_ No. of compartments..._...;il��.--....-. _A-„S_'Liquid depth_...-�.... ........Capacity---- ---V---- Dispos Field: Distance from nearest well.-----Xg!--Distance from foundation....-gip.'.......Distance to nearest lot line-slf--------. Number of lines.---------_?-------------------Length of each line-- --Pa-..--- . Width of trench__ Z..- ------ .. Type of filter material---- S.�r-_.....Depth of filter material_-_--1.9..______Total length....... Seepage Pit: Distance #o nearest well------ ---- ---------Distance from foundation--------------------Distance to nearest lot line----------------( Linin material---------------------- Size: Diameter---------------- -- --De th-------.------------------ Cesspool: -----_ - ❑ Number of pits--- ---=------------- 9 P ----- - Cesspool: Distance from nearest well ----------------Distance from foundation_---...--........ ..Lining material--------------------.-----------_-__�V 4 Size: Diameter. .. ......... ..... ... ...--De th--------------------------- ---------...Liquid Capacity -------gals. Privy: Distance from nearest well------------------------------------- ---------Distance from nearest building._-.__--___________.____-____-_______ ❑ Distance to nearest lot line --- ---------- .............. ---------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------------------------- 1!! --- --....-------------`----------- --------------------------------------------- Lyn I hereby certify that I have prepared +his 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. r. O� N: # (Signed) ------- and/or Contractor) --- -- --- - --------------------- (Plot plan, showing-size of la+, Location of system in r "ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----------------------------------------------- DATE. _0'79. - ------------ --- - - - REVIEWEDBY---- ------------------------------------- -- ----------------------------------------------- --------------------------------- DATE------------------------------------------- -------------- - -- BUILDING PERMIT ISSUED.------- -- - ------------------------------------------------------------------------------------- DATE--------------------------- ------- -- - --- - - -Alterations and/or recommendations-------- ------ --- --- -- ------- -------- -------------------------------------------------------------- ---------•----- ------------------------- ------------ -----------------•-------- ------------------------------------------------------------------------------------------------------------------ ------ ------------------------------------- ------------------------------•-----------------------------...---------------------------------- ------ ----------------------------------- -•--- I FINAL INSPECTION BY:- - . Date-.-� I fg SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E.Hazelton 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