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FOR OFFICE USE: O--1 � - --- -- ------------- . __________ ____ ----------- -_. :__. .. APPLICATION FORy SANITATION PERMIT Permit No. ------- ------------------------------ -------- (Complete-in Duplicate) --- This Permit Expires 1 Year From Date Issued Date Issued �d_�_/7__-�� Application is hereby mads 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 LOCATION___ ------------------------------------------------ Owner's Name----------(2, �_, , 2 ---- '�Lai�_ Phone ,7X __ ___1_.._ _-.__------- -@LA. __ ---_ _.___-___•.--_---_ ________________.. Contractor's Name---- - ----- ----y,=rQ ------------------- Phone._ _ - ----• 1 Installation will serve: Residence partment Ho er us Commercial E] Trailer Court ❑ Motel [I Other ❑ Number of living units: __/__ Nu of bed _..__-- Number of baths -------- Lot size ... Water Supply: Public sysfe Community system ❑ Private Depth to Water Table 49 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay �Hi Y ❑ Y ❑ y ❑ Adobe�Hardp;l`•n ❑ �'' Previous Application Made: (If yes,date--------------- ) No ❑ New Construction: Yes ❑ No .FHA/VA: Yes ❑ No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permittedV111 ublic sewer is available within 280 feet.) .PSeptic Tank: Distance from nearest w ....._Distance from foundation-__-/4-_______.Material ._. -------------------- No. of com artments_. ....__ r // Ln e_Uquid depth_ ---- - .Capacity i p -- Size - :- - -- - '� A` � - --- p Y•--/�_OL7.�r�� Disposal Field: Distance from nearest well-P..01...Distance from foundation__�p ....Distance to nearest lot line___./C�ar//- : Number of lines.___ ___------------------Length of each line-7,5`111---------------Width of trench_. '!.____.._._ --- Type of filter maferiaN. Depth of filter material-__-- ____.._Total length____/ -6-!..-_ r r Seepage Pit: Distance to nearest well�,3Q --______Distance rom foundation_��_._.___..Distance to nearest lot line__._f_(.7__--. ' Number of pits--P- Lining'material_- Size: Diameter_- �� Depth._ Cesspool: Distance from nearest well ________________Distance from foundation.- ----._ -.Lining material__-._________._.__.-______._____. .. ❑ Size: Diameter_ __ _________ _ ----- --- ....._.Depth_-.- --------------------------------------- ------ Liquid Capacity ------------- t -------------gals. ______ Privy: Distance from nearest well_____ ___ __ ____-...._Distance from nearest building El Distance to nearest lot line-------------------- p 1 Remodeling and/or repairing (clescribej:-----------------_ ---.---------------------- -- --- ------------ --- --••--------••----------•--------------------------------- --------------------- --------------- J `�� . ------ ► y - -------------------------------------------•--------------------------------- I f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rule!) and regulations of the San Joaquin Local Health District. i (Signed ;a -------•- - ----------------- (Owrror Contractor) -------- 8Y: . ••T-----------.:---- �"-- �---- --------- - -- ----- �. (Title) (Plot plan, showing size of,lot,-,location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-- _ -~ ------ DATE_. _ _6- .-1 ------------------- DATE - - d f REVIEWED BY - -------------------•------------- - -- ------------------ - - ------------ ------- ------------------------------ DATE ----------- UILDING PERMIT ISSUED-- '--- --------------- -- - - -g ----------._ DATE. - -- -- ----------------------- ----------------------------- Alterations and/or recommendation -----------_ -------- ------ ------- '" ----------- -- f ---- ----------------- ----- ----- ------------------------------------------- ------------------------------------------- ------------------ - ---------------- ------ - ----------------------------------------------------------------------- ------------------- FINAL INSPECTION BY:. --- �-- - Date CD-: c'7 7- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon 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