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FOR OFFICE USE: --------- # APPLICATION FOR SANITATION PERMIT Permit No. .........- <,-- ---- - ------------------s ------- ------- -- - (Complete-in Duplicate) _ ..... - --------------------------------------------------- Date issued —�-3.'-- _--------- 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. 549. JOB ADDRESS AND LOCA ION.----, f-- I ------ -, ... .--------------- -------------------------•--------- Owner's Name------- AA_ ........ -------------------- --------------- ------------------------------ ----------------------- Phone------------------------------------ I Address----------- Ao� Contractor's Name--------- pe 7? Ga------------------ ------- ---------- •- Phone 1 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/_`Number of bedrooms _ +_- Number of baths -... Lot size Z-a-C�-- ------- ------------------------ Water Supply: Public system ❑ ICommunity system ❑ Private [Depth to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91074ardlean ❑ Previous Application Made: Ilf yes'date..__....-_-__--_.- 1 No Kjo'New Construction: Yes 0 No F�— FHA/VA: Yes ❑ Nom. r . TYPE OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.)_. t Septic Tonk:/ Distance from nearest well...., e Distance from foundation....................Material....:-..-_-____.-.---------..--._._.___.___---- `` No. of compartments------ ------------------Size-------------------- ----- -----Liquid depth--------- -- -- ------- Capacity------- -------------- f r Disposal Field: Distance from nearest welllla....-Distance from foundatiio/on ..9-.-....Distance to nearest lot�line�------- ®� Number of lines_-....�----- -----.... ength of each line._1&A0. _ _ Width of trench-___A...............____----- Type of filter material �P -.---.__.Total len th__ r+ . ............. Depth of filter material--_ g f t, Seepage Pit: Distance to nearestg ell..., AF...Distance fspm f ndation_. ---------------Distance to nearest lot line-.s�...-. ®/ Number of pits.-.�---------.__Lining material-XT-19 __ Size: Diameter___,.7�........ Depth............y` " Cesspool: Distance from nearest well ----------------Distance from foundation---------___ -. ..Lining material------------------_----------------.. Size: Diameter'-- -------------- --------------.Depth------------------------------- - - -------------...Liquid Capacity----------------------------gals, s Privy: Distance from nearest well------------..............._-._....--- ----._-Distance from nearesf building------------------------------- --.- ❑ Distance to nearest lot line ----------------- ------------------------- -------•----------------------- I Remodeling and/or repairing (describe):__...-.. --. -- �"� - ------ �1�*� I I •--------------------------------------- -----------------------------•----•-------------------•---------------------------------------------- ---------- ---------- -------------------------- ------=--------- - - ---------------------------------------------------------------------------------------------------- -- 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. 1 (Signed).. r. .. Q - _ _!.--- --- - ` ------------------------ -------------- ---. Contractor) .. ----_----- --------Title (Plot plan, showing size of lot, location of syste . relafion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ - -------------- DATE--- -------�--------------------- - -- -------- --- -------- ---------.------------ - REVIEWEDBY-------------------------------------- --- ------------------------------- -- ----------------------------------- --------- DATE----------------------------------------------------- BUILDING PERMIT ISSUED-------- -- ------ -. DATE----_-------------------- ----- ------------------------- Alterationsand/or recommendations:------- ------ ........ - ---------------------•------------•----------------------- - ------------------------------------------------------------- I 4 FINAL INSPECTION BY:-. ._ .. Date. -4-------------------------- SAN - _-- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT _; 1601 E.Hazelton Ave. 300 west Oak,Street 124 Sycamore Street 205 West 9th Street Lodi"California Manteca,California Tracy,California Stockton,California E.H.9 2M 1.67 Vanguard Press