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FOR OFFICE USE: ---- ----- ------------- - ----------- -. . APPLICATION FOR SANITATION PERMIT Permit No. ....................... (Complete in Duplicate) --------------- -"-- ----------------- ----- Date Issued l - ---------------------- ----------------___-------- 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 th�e-work herein described. This application is made in compliance with County Ordinance No. 549. �, 4#j►tA/y)K J_J ICZe C- JOB ADDRESS AND LOCATION ----�'/�-�--2&�--/y! V� Ov{-,Ot� -.l- 4 sSfG - / A,/ � 1 4-44-61FW7t- 0�4-----' f,9.. Owner's NamellL��/ -C.Q -!--/f '� ------------ -------------------- Phone �{ ,� -• Address-/O- = Q� - -� L-tS �- ••--� �rr` ! f ` Contractor's Nam -c __:L1_ _` l_Y1AT- ac �- # !!4� PhoneL� t Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __ ----- Number of bedrooms #..____ Number of baths--------- Lot size ----- ... __.____ -------- ____________----------------- P Water Supply: Public system El Community system El Private [Depth to Water Table ...... . ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ( Clay Loam [j Clay E] Adobe (3 Hardpan E] Previous Application Made: (If yes,ddie-------------_..._ ) No ❑ yNew Constru$tion: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well/ti�l�-.--Distance from found tion-.��_._.___Mater I 6�1�/L�- - -- --------------- No. of compartments.-- - ----- Size, &t_Ar Z�el .11, depth_.. �i--------Capacity- - ----- � j � Disposal Field: Distance from nearest we ��' Distance from foundation---/0---_---..Distance to nearest lot Number of lines ................... --Length of each linej�Q__�_._. / ---------Width of trench. .__..__ Typeofilter material ___Depth of filter material-------- �f�-Total length---.____.__--,�Z ----- A s Dt d s r Seepage Pit: Distance to nearestllwe ---------------- _-Distance 4 from foundation------------------- Distance to nearest lot line--._-._.--_-__- ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-------------------.---Depth-----------------------------.--- V Cesspool: Distance from nearest well ................Distance from foundation................_ .Lining material-----------------------.__--_-------- O. ❑ Size: Diameter. - Depth------'------ - -- ----------- ------------1------._Liquid Capacity-------------- -------------gals. Privy: Distance from nearest well...... w....t--_ -------�_-_.-..__-_--Distance from nearest building ElDistance to nearest lot line •-------------- - - ----~ ------------------------------------- --------- --------------- ------------------------•-- ----------- Remodeling and/or repairing•(describe):__--- .... --------------------------------------- ------------------- -- i`r/ .�11� f�S — tS=r OjI � d r ---- I hereby certify that I have prepared this application and that fhe."rk will:be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sari Joaquin Local Health,District. DAY&NMtMT (Signed)-- ------------- ----------- = ---- ---------- (� Contractor) 13 r HO P -- ----(Title' �:..... Y ------ (Plot plan, showing size of lot, IOCaTion of system in relati +o wells, build' gs, etc., carP61placed on reverse side). ti -0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... _---- ----------- DATE... ------------------------ REVIEWEDBY------------- -'---------------------.- ----------- ---------------------------------------1 -------------------------- DATE---- ------------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- -- �--------------------------------------------------- --------•------ ------------- DANE--.------------- ---------- ------ -------------------------- Alterations a d/or recommendations:.,..,("�f -.-P..-_--_--�3. --__ - .� I © •-- ` �- '=`®'"` f� -------- 4 --- --------------------- ---------------------------------------------------- . ........................--------_...--------.----- FINAL INSPECTION BY:- �---------- . .- ---------------- -- ---------- Date--- ---.��r`2-------------7 ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press