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FOR OFFICE USE: 4 ................. - ------ ------------- _ I S ___-_; APPLICATION FOR SANITATION PERMIT Permit No. . .�. ''' � 3. ------ �................•' (Complete-in Duplicate) Date Issued - "` ------------------ --- ------- This Permit Expires 1 Year From Date Issued_ Application is hereby-made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinan e No. 549. JOB ADDRESS A D O/CTION �,Tp - ----------Z 7 Owner's Name_---Ff�--��'b �---------------------- --- --� -- -•--- . - Phone-/-,3_- -.;33Sr Address............... --- ------------------------------------------ = - ----------------- Contractor's Name -- - ---- -------------------------- Phona4ki17,f4i , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i i Number of living units: ..l-.. Number of bedrooms ., .. Number of baths .7r.. Lot size .Ip�..-...- ....Z-QQ__---._-...._-___---- Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table�60_ ft , Character of soil to a depth of 3 feet- Sand ❑: Gravel E] Sandy Loam El Clay Loam El ; Clay C] ( Adobe.K Hardpan ❑ Previous Application Made: (If yes,date_- ... } No a New Construction: Yes ❑ No N-. FHA/VA: Yes ❑ No Uk TYPE OF INSTALLATION AND SPECIFICATIONS: {{ {No septic tank or cesspool permitted if public sewer is available within 200 feet.} ! I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material .._..._...--..---- -.- . -. ❑6v,t541AAr .No. of compartments------ -------_....... ..Size-------------------- -----------Liquid depth--------- ------ --------Capacity----- --- Disposal Field: Distance from nearest welIXIV.N6,_Distance from foundation.. .............Distance to nearest lot line-- ------- Number of lines--.�.I. .. . ...... ... Length of each line_ ..��"/f1_ Width of trench..e �"-.-.-.-_ ___._... Type of filter material.....- _ Depth of filter rnaferial..-. -�5-.-- ------.Total i length-------------'.--- ---- -•-• ---------------- �u a Seepage Pit: Distance to.nearest w\\ell..��,?_1�E_•_Distance om undation.��.=_...Distj nce to nearest lot line.�.�... Number of pits..0-A Lining material._.__ Size: Diameter__ F;_. _-.. -----Depth--�- ----- ........ `11' Cesspool: Distance from nearest well ----------------Distance from foundation----------------_ ..Lining . material. -.---..---_----.----..-.___..-------- ❑ Size: Diameter. .. -------- ----- ------ - -------Depth- . - -- - --- ..................Luid Capacity----- -- -------------gals. d Privy: Distance from nearest well......::..:.......f...._.---------..._..........Distance from nearest building....----- -----------------------. ❑ Distance to nearest lot line........ ...... I - -- - ---- _j - ... --- .-- � Remodeling and/or repairing (describe):--Cr --------------------------------------------------------- ------------ `- ------------------------------------------- t ----- --------- - ------------------- -------------------------- -------------------------------------------- -------------....-..------------------------- ---- - ---- - -------------------------- - -------- ----------------------------------------------------- II _ 1 171 � r ------------------------------------ - ------•--- •-•------------------------------------------------------------------------------------------ -------------- ----- I hereby certif I have prepared phis application and that the work will be done in accordance with San:Joaquin County t ordinances, State aws, a rules a regulations-of e•San Joaquin Local Health District. *` (Signed) - }. --------------- --------------(Owner and/or Contractor) By:----------------r .��L.---- ` .... --------- . {Title) Y (Plot plan, showing size of lot, location of system in elation to wells`; 6uildiri'gs, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY II ` APPLICATION ACCEPTED BY-- -- -' -.-.-.. -cQ ------ ---- --- ---------------------- ----------i DATE-57] b REVIEWED BY DATE BUILDING PERMIT ISSUED-------- -- ---- -- TE__ Alterationsand/or recommendations:-- -----. -- -- - ... - �,�- -- ------------------------------- f�----------- ------------ ----- ..... �_._ � l�� ........-.--------------- ......................................... -------------- ------ ,FINAL INSPECTION BY:_."/--_ . Z� ----- --- Date-_- _S ----- 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 Tracy,California 4 E.H.9 2M 1-67 Vanguard Press