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FOR OFFICE USE: - �C7 a = --5 -------- ------ i APPLICATION FOR SANITATION PERMIT Permit No. . "-.J • - ------------------------------------- ---- ---------M--- -/ -------------- ------------------- 3---- (Complete-in Duplicate) Date Issued - -= --- -- ---------------------------- '!-_- 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. 1, /� JOB ADDRESS AND LOCATION------ -•-----$Ve... -- 4007./`�..�x V Owner's Name ��1�------ - --- --- ----------- ---------- ----- - Phone_ Address ---�-----------•----- ----------•---------------------------- one - Contractor's Name----- > ° <- � ` -------------- ------- ---•------------------- Ph I!` Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living uniIIts: -/--- Number of bedrooms _9__ Number of baths.Z___ Lot size _._ -------- ------------ Water Supply: Public system pp"tommunity system El Private E] Depth to Water Table ft { Character of soil to a depth of 3 feet- Sand ❑ Gravel F1Sandy Loam ❑ Clay Loam ElClay ❑ Adobe we-0111ardpan ❑ I� Previous Application Maden (If yes,date_---------..-----.. ] No V?' New Construction: Yes ❑ No [n—FHA/VA: Yes ❑ No ` TYPE OF INSTALLATION]AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) t Septic Tank: DistanIMce from nearest well____..:___..-__-Distance from foundation___....._----------_Material.-._._______-_____._.....___________..----------- Liquid depth--------- ------- --------Capacity r � fsl�/fV No. of.!Compartments-------------- _._-Size------------- . I i Disposal Fjel): Distance from nearest well-----------------Distance from foundation__..___.. ........---Distance to nearest lotine___-_____.--.-___ Number of lines--------------------------=-------Length of each line_. -------- ------Width of trench--------- ------------------------ Type of filter material-------------------------Depth of filter material----------------------Total length-------.--------------------------------- Seepage Pit: Ristan I�e to nearest well r " -.. """ ___----__Distance from foundation---11i6d._-------Distance to nearest lot line-- 7.l __-__..- 1 � . ,Num of pits---/---------- -_Lining material- Sizer Diameter �epth -/� --- ---------------- i - __ Cesspool: t_,_Distance from nearest well --._._____..._-Distance from foundation... - Lining*material...............- gals. La uld°Ca acit ---- ❑ Size: Diame#er- - ---- --- ---- ---- Depth 9 Qt:..p �Y Privy: Distance from nearest well----#-------------------------------------------Distance from nearest buildirig------------------------------------------ • I i ` ❑ :. Distance to nearest lot line ------------- .............. -- --- ------ ---f--------- ------------------ -----------------------------------------------------------. ,, I� 71 to. . - - Remodeling and or repaii•;in (describe)_----___--------�.-.---.----_ -------- ---� - - - ---- ------ - ------��- .... L x . ------ -------------- ------------------------------------------------- l ereby certify that l h p epared this pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, an I rules and regulations of the San Joaquin Local Health District. O Contractor (Sign ', _n,,�..r.- --- ,� -. ' --------------------------- ---- ( � --.......... :I' 1 -------- -- - (Plot plan, showing size of;lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). � 4 FOR DEPARTMENT USE ONLY IEcaZ / APPLICATION ACCEPTED BY.-------- ---------------------•-- ------ --- ----- ------------------ ----------- ._ DATE REVIEWED BY------------------ - - ._- --------------------. DATE-------- --.------------------------------------------------ BUILDINGPERMIT ISSUED-------- -- ------------------------------ --------------------------------------------------- ----- DATE-------:------------ - ------- ----------------------- Alterati sand/or recommendations: - -------- ----------- ---------------------------------------------------- / efeilt t� -------------------- -------------- ---------------------------------- --------------...---------------------------------------------------- -------_------------ i� - -------------------------- ------ ---------------------- ------ ---------• ------ -------- --------------- ------------- --- - ----- ---------------- FINAL INSPECTION BY:------- - --------------- --- ----------------- Date--------�.. �-� --fix-- ---- -- - --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.NZ.1fon Ave. 300 Wast.Oak Street "R 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press