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FOR OFFICE USE: -- --- --- -- - ------------------------------I ------------ ---- ------- APPLICATION FOR SANITATION PERMIT Permit No. 1&40. ----------------------------------------------- --- (Complete in Duplicate) Date Issued ---------------------------- ----------------Z---------- - This Permit Ex fres I Year From Date Issued. Application is hereby.made to-1h-i_g",J),oaq(jiwLocaI Health District for a permit to construct and install the wor her in escribed\ This application is.made in c'6mplfa_h6b-with County Ordinance No. 549. construct JOB ADDRESS AND LOCATIONA ... ....6 & - ---- ---------- ---------- -------------------------- T --------------- Owner's Name----------- --------�_.I Address----------------------- ----1- -------- -- � ------------------------- . ...................................... Contractor's Name ...... ------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House E] Commercial ❑ 'Trailer Court Ej . ofel [] Other Y, Number of living units: Number of bedrooms___ Number of bathsal!�,Lot size ------X_ _._d44_jiw------------------------- Water Supply. Publi6 sysfe�m-`Ll- .Community system PITrivafe E] Depth to Water Table 16 ft: Character of soil to a depth of 3 feefi,+ Sand E] Gravel [] Sandy Loam E] Clay Loa`m,E�l Clay 0 Adobe [R--5a_rdpan ❑ Previous'Applicafion Made:. (If yes,da'te------------------1) No New Construction: Yes � f FHA/VA: Yes �No F1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dstance from near f est welt------=_ ---Distance from foundation-/ ---- Mate is CC._0_41C* - - com I Te ) LNO'�_ No. parfmenfs..-3---------- .......Size_. 47_Liquid de0h------- -----------------Capacity./_2.VW,_7------ I. t V - Disposal Field: Distance from nearest well__mw��Dlsfance from foundation,/4/_s_.___Distance to nearest lot line_S?----- Lioe"" Number of lines--- Z---- Length of each line--- Width of trench.a...Y--If/--------------- .I Type of filter mafiAkL----RQ- Depth of filter material.... _ _%__-----Total length---/,SV-/---------------------- Seepage P, Distance f nearest �0 0 sf well. — �DistanGe.-jj-orn_foundafior---/ -I__ Distance to nearest lot line--6---------- ---- ---------- - ' 5� Diameter:,. .-Size.- ,3_0"o--------Depihacye?�� Do' Number of pits- {t_ y-___Lining materi�f_kf.Qx�k_ Cesspool: Distance from nearest well-----------------Distance-from foundation.- ._-----..-----.Lining material______-_-..---_---._-.-- ------- ❑ Size: Diameter------------------------- ,--��'--�--------------��--.-----Distance -Dep;h_, ------------------------------------------------ Liquid Capacity-. .-----------------------:gals -� ".. from nearest b0ding------ ----------------------------------- Privy: Distance from nearest - --❑ Distance to nearest [of fine- ------------------------------- g ------------------------- ------- -------------------------------------------- '---------------------- Remodeling and/or repairing [describe)-------------- ------ ---- -------------------------------------------- 4 -.-- - - `----- ---------------- -------------------- -------------------------------------------------------------- : - P�� ------- ---------------I------------------------------ ------------------------------------------------------- --------------------------I--------------------------------------- --------------------------I----------------------------------------------------------------- I -I L ------------------------------------------------------------------ ------------------------------------------------------------------------------------- ------------------------------------------------------------- I hereby certify that I have preI4arlecl this application and that the work will be done lin accordance with San Joaquin County ordinances, State laws, and es and r1egulat' of the San Joaquin Local Health District. ---------------I Glonief-and/or Contractor) (Signed)-------------------------10-�10_- --------- ----------fa----------- ---------- --- - ----- By: ---------------------------------------------- 1 ---------------(Ti ....... ------------- ---S79) (Plot plan, showing size of lot, location of system in relation to welTs—, 6uildings, etc., can bp placed on reverse side). _4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- ------- --------------------------- DATE---- �, 1 E REVIEWED ATE----- REVIEWEDBY----------------------------------- ------------------------------------------------------------------- ------------------ DATE BUILDING PERMIT ISSUED_ - --- - - ---- -f_ ----------------------------------------------- DAT E Alterations and/or recommendations_/ / -a ----------------------- ----------------------------------------- -------- - ------ ---------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------ --------------------- ----------------------------------------------------------------------------------------------------- ----------- -------------I----------------------------------------------------------------------- ----------------- ------------------------------------------------------- --------------- ------------------------------------------------------------------------------------------I---------------------------------------- ----------- ---------------------- ----------------- - ----------------- ------------------------- --------------------- ------ --------- ----------------- ----------- -- --- ----------- FINAL INSPECTION BY:-- Date. SAN JOAQUIN,LOCAL HEALTH DISTR , il ��, -------------- ------------------------------- 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.CO.