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FOR OFFICE USE: II i ------------------- =- -•--------------- -------H---- -------------------------------- ------ ---------.-..-__-________________------ -_.. APPLICATION FOR SANITATION PERMIT Permit No. .Cf -----•------------------------- --- --- ol {Complete in Duplicate}t Qate Issued 1 _' rz _ � ! -------------------------------------------------------- This Permit Expires fires 7 Year From Date Issued ; Application is hereby made.to the San Joaquin Loca3 Health District for a peAit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ------------------------------------------------- 4 0 JOB ADDRESS AND LOCATION_______ .:-----: 7G`t-- -'--_- - � - f Owners Name--- Address � ---------- --- � v--------------- - ----------- _ Contractor's Name----------- •-- -----f'----------- ----- ------•-•---------------------- Phone-----..-----•--•----- -------------- Installation will serve: Residence Apartment House ❑ Commercial .❑ Trailer Court ❑ Mot j ❑ Other 1] / Number of living units: -__/___ Number of bedrooms _-� Number of baths -'2-- Lot size _- ------ --------------------p_-___ --------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table_n_ ft. Character of soil to a depthof 3 feet: Sand ❑ `Gravel ❑ Sandy Loam ❑ Clay LoamClay ❑ Adobe❑ Hardpan C] •li I Y ❑ JR--No ❑ FMA/VA: Yes ❑ No ❑ r� Previous Application Made. , If es,date-. --- _) No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I .l / Septic Tank: Distance from nearest.well___.______ istance�from foundation__- _ '-.__-_.Material_-X�� / r, NX No. of compartments____________ _____________Size_-� _-/V�._6Liquid depth__--___-.yam..._______Capacity_yl_r7� i j Disposal Field: Distance from nearest well-----------------Distance from foundation--------.-----------Distance to nearest lot.line_________--__--- I ❑ Number_,of lines-----------------------------------Length of each line------------------------- Width of french--------- _----,------------•-, Type of filter material-------------------------Depth of filter material----------------------Total length_____-____-.--___-_-_ 1 Seepage Pit: Distance-;ao nearest well-------_--------------Distance from foundation--------------------Distance to nearest Ibi line--___-_-_______._ ❑ Numberlof pits----------------------Lining material-----.`-------"-:"--..Size: Diameter-------------------___Depth-___-_-__-_-_____-._-_____------ �} Cesspool: Distance:from nearest well-----------------Distance from foundation--- ----------------Lining material____-----------.------______________. ❑ Size: Diameter--------------------------------- _--Liquid Capacity als.. :;:_ Privy: Distance from neatest well_____-_---_.-----Depth-_______-----__ ----Distance from nearest building Y •, 'a t ❑ 9 Distance to nearest lot line-------- --------------- -------------------------------------------- : . . Remodelin and/or re iairin� describe): ` _ - ~� _ 7k,_: � I 9 / p - ,` --•---- ------ --- ----- ------ ------- - -------�".------------ I q ( •--------- c-CSC- d. v�� � -- --------------- t e7 -----"=`------s---- '4'' -`=`---`-"`=�-`----- -•--e �{-.�� _->- `---- '`------------ - -� - I hereby certithat I have prepared this application and that the work will be done in accordance with San Joaquin unty ordinances, Staf lours;and rules and retions of the San Joaquin Local Health District. cam✓, ii (Signed)•----- -------------------- --- ------- ------------------------------------------------------------(Owner and/or Contractor) By: -- - - -- - ------ - (Title)-------------------- (Piot plan, showin size ot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - �,._.. DATE 'z z. ----- ------------------------------------------------ ---- --- REVIEWEDBY---------------------- ---------- ----------------------------------------------------- DATE BUILDINGPERMIT ISSUED-8-------------------------------------------------------------------------------------------------. DATE-------•------------------------------------- ----------- Alterations and/or recommendations:------- - ------ ---------- ------------ --------------------------------------------------------------------------------------- --------- !I ----------------------------------------------------------•---------- --------------------------------------•-------------------------------- ------ --------------------------------------•-----------•------------------- I! ----------------------------------------------------------------- ----------------------------------------------------- FINAL INSPECTION BY:-, -- ---- -- ----------- ---- ---•�r�s��--- Date- --C-- ------�--� ---•----------� ----------- ------------- ii SAN JOAQUIN LOCAL HEALTH DISTRIC 1601 E.Haxellon Ave. i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California II F.P.c n. c