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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 here[W made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------4.6-7-1------- A—VE- ------------------ I t(/ Owner's Name--l"74-my_ ____.�r_ 1-.1,? `_ ----------------------------- _ --------------------------------------------- Phone..-JD_So..�--45— Address---------Z6_0 i E-----AS-----f4F_i,0Ll Contractor's Name---6 _ E----------•-------------------------------------------------•----------•-------------------------------------------- Phone........................---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6Z gDRm 140115ErF 1 VGL rRnILVRZ r Number of living units: _2Number of bedrooms _5--- Number of baths _-'2—. Lot size __1D0__X_1.7'S7_____________'_________-___- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EK Hardpan ❑ Previous Application Made: (If yes,date_,zh _3__.) 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 Tank: Distance from nearest well__�'-6_--_.___ DFstance fro4 foundation-_.f Material__- - - ! ._�_ '- -(6YISTIMC)lo. of compartments_.:__.___ r______________Size___ _�___ ..__ .Liquid de ¢� pacify- trs�a Disposal Field: Distance from nearest well-_,-50__`-----Distance from.foundation.-,-] __Distance to nearest lot line....S._ _._. Number of lines------I...... t-�-__--_-__-Length of each line----- - .�'_ .Width of trench____ - 4-�."_�}_______________ 4"Aov 80' Type of filter material...90C.V----------Depth of filter material -__._J_$_.`______._Total length_..__ _`___•__t?_..0.--.__..._ Seeeppag Pit: Distance to nearest well----------------------Distance from foundation-------_............Distance to nearest lot line__..---.......... ❑ Number of pits.---------------------Lining material--------------`_..._:...Size: DiameterR---------------------Depth-----------------•-----------•-•- Cesspool: Distance from nearest welL_______________Distance from foundation-------------------_Lining material--____._______________________---_--- V ❑ Size: Diameter--------------------------- ---------Depth------------------------=_------=------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____ .__.______________________-____Distance from nearest building---______-._______________-___________-_. ❑ Distance to nearest lot 1ine---------------------------------- ------- -------- Remodeling ------Remodeling and/or repairing (describe):------ 17 /.rJ-a------- -Q:f____K---l�fk�' ----y,1'V-€.----7------- l».91aft ---------- 1.Qp------•------------------ -------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------•---•------------••--------•------------------------- 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 regulati s of the San Joaquin Local Health District. (Signed}-• = ---.• - ----------------------------------------------------------------------------------(Owner and/or Contractor) F 7 B ...(Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). --�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------ DATE---- " 't REVIEWEDBY----------------------------------- ------ ------------------------------------------------------------- ------------------- DATE-----------------.... BUILDING PERMIT ISSUED--•----------------------------------------------------------------------.. _--------------- DATE------------------------ Alterations and/or recommendations:------------------------------------------ - - -------- --- - - -- -- C2 --- -- - - - ------ ---- - - -- ------ Ft -- ----- •-----•-- ---- --- ------------------------ ------------- �- - r ---------------- -- -- - / LII UP P %I C_� 77",9 Cf f7 7-0 �/CUw. ' FINAL ! SPECTIO BY-------------- - -- •- ---- ---- Date------------------_----- � Q't ------ ---------------- ----------------------------------- S�� 9 6 2 of N JOAQUIN L CAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Californto Lodi,California Manteca,California Tracy,California E6�9 REVi9 rp a-59 F.P.0 D.3M 6-60