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FOR OFFICE USElime : i APPLICATION FOR SANITATION PERMIT Permit No - - - -- (Complefe•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 the work herein described.`' This application Is made in compliance with County Ordinance No. 549. JOB ADDRESS AND`L/OCATION.//.-_-�.. YJ41-AP,"------rAr-SA;-7_/�--'.__.Y�--fl.��./[��j•��.-- Owner's Name---------/:7�1.�/'G�A--_.(e ._�'- _S. -------- ----.. Phone---------------- Address----- - - re --------------------------- - - - - - - Contractor's Name.----- ---- Phone--------.-----------... . Installation will serve: Residence g4,lApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-- Number of bedrooms A. Number of baths Lot size <&d e^e, _�.-._-.__---------_--_--_ Water Supply: Public system ❑ Community system ❑ Private yrlDepfll to Water Table/ri- ft Character of soil to a depth of 3 feet- Sand Gravel Sand Loam ` P ❑ ❑ y [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 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 permitted if public sewer is available within 200 feet.) v Septic Tank: Distance from nearest well.._._------ Distance from foundation-------------------Material -----_. ----------_....--__- 1i�lJ><`?�ts' No. of compartments._-------.-...__...Size-------------_-----------Liquid depth....----- -._— ---... Capacity.---------------.-- b ` Disposal Field: Distance from nearest Distance from foundation.ZA&----------Distance to nearest lot Annie f /.el Number of lines- ----/--_,, -- --- --.-.Length of each line- G lJQ�_.'- -.-....Width of trench.... _.°.._._............._ � Type of filter material/_,41e-00.e.'.Depth of filter material...f_�.C�``_---Total len th.-- +L 9 ��... --------------- L ----------L Seepage Pit: Distance to nearest well ..._.__ -------._Distance from foundation-----------------.Distance to nearest lot line_--------_._. ❑ Number of pits------------------._Lining material.--------------------- Diameter................._-- Depth---_-----------.__..__....__--- \ Cesspool: Distance from nearest well -------.--------Distance from foundation........__._. ..Lining material---- ------------------_---_---- \ L ❑ Size: Diameter. -- -- - - --------------- Depth---- _ -- ------------ ------ .Liquid Capacity....- _ - ..gals. Privy: Distance from nearest well-----_------------.__._............_ ......Distance from nearest building.-_--__.-_._._.. ❑ Distance to nearest lot line_ _ ------ -- -- ----------_--------- ------------ 6 -- k` 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 rulesand regulations of the San Joaquin Local Health District. (Signed)-------------------- Q../.8.:`�L.-: --------....... - --- ---- (�"aar•-errdfor Contractor) By:------------------------------------- --------------------- - --------------- -- (Ti+Ie) � � ✓ (Plot plan, showing size of lot, location of syste ' relation fo vyel(s, buildings, etc., can be placed on reverse side). It■ FOR ?EARTMENT USE ONLY APPLICATION ACCEPTED BY_-rTl ---------------------- ----------------------- - ---- DATE-- --� -- REVIEWEDBY----------------- -------------- -- ------------------------ - -- ---------------------I--------_ DATE-------------------------------------- BUILDING PERMIT ISSUED------ -- ------------ — -- ---—-------------------------------- DANE------- ----- ----------------- ------ -- - Alterations and/or recommendations: `------------------------------ -......------------- ------- - - - -- _. ----- -- -- - FINAL INSPECTION BY: . J Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi California Manteca, California TIOCY, California 6. E.H. 9 TM 1-67 Vvnguard Press