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FOR OFFICE USE: ----- -- --------- - ----- ------------- ------ ---- . APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) Date 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. 544. f �T� JOB ADDRESS AND LOCATION..... -----2. - -----w -m_4---------R_0'--=-- � " Owners Name---. -- A-----------Alepzvlve2�6--------��il��---- ------ Phone---��^y AW- .-----------r --s Address-_ -- -: - _ ------- JJ//�/^ 1 fJ "(� •------------- 7�----------- A Contractor's Name !-3 _- `' �f- --------- Phone Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedrooms---- Number of baths-------- Lot size ----- ---- ..------- ------ -------------------------------- Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table -d`_ - ft Character of soil to a depth of 3 feet- Sand g Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Q Previous Application Made: (If yes,date-----------,-----_- l No ® New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE-OFryINSTALLATION—AND-SPECIFICATIONS:-=• -�W '�'"` '� �"�� "' " "'�— `"'"" " " " �°Rs— (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��— 1�s Septic Tank: Distance from nearest well ---_t ..--Distance from foundation----.- -b-------Mater-ial ---- t --- -- - 0 U depth_ , . -----.Capacity---4's - ------- ❑ No. of compartments.-._...--1�_-_-_...........Size-- ----X--- lf.---Liquid - ------ - -- Disposal Field: Distancefrom nearest w9..... ...-Distance from foundation----46---------Distance to nearest lot line-----�_------. ❑ dumber of lines-----------------------------------Length of each line--..____---74----------Width of french-----.Z---..--___--------------. Type of filter materiai----/-a_ '< .---Depth of filter material.--..IR...........TotaI length---.._-o� - ... ------------------- Seepage Pit: Distance to nearest well......................Distance from foundation---.----------------Distance to nearest lot line--.-----_---.--.- ❑ Number of pits--- ------------------Lining material---------------------_ Size: Diameter-----------------------Depth.......----------.--------------- 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---------------------------------- ------ Distanceto nearest lot line----------------- ------------------------------------------ ----------------------------------- ------------------------- Remodeling and/or repairing (describe):---------------------------------- --------------------------------------------------------------------- -----------------_---------------------------- ` ----------------------------------------------------------------------------------------------------------------------•------------------------------------------- --------------- ------------ 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). e f I�r c/ �f - --- - ------------------ - ------ ---- ----- -(Owner and/or Contractor) �- By:-------------------------------- ---------- ------------------------------------------ - ------(Title)----------------- -------..---I- ------- 11- ---------------- (Plot plan, showing size of loft, location of system in relation tz(wells, buildings, etc., can be placed on reverse side). FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY------__T_(.t3. ---------------------------- ------------------- ------ -------------- DATE--- --------------- REVIEWEDBY----------------------- 6-------------------- - - --- -------------------------- ------- -- --------------------------- DATE-- ---------------------------------------------------------- BUILDING PERMIT ISSUED DATE 1k ---------------------------------- Alterations and/or recommendations:-----2.wZwr -"------.7A-N-K-------- NA,L, , D----c -.- ---------.--------------------- -------- -------------------------- --------------------------- ------------------------ ------------------------------------ - -- ----------------------------- ---------------------------------- -------- -- ------------- ---- --------------------------- - - ----------- ----------------------------- FINAL , ECTION $ - --------- Date----------------�- f� ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press