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`. -- -------- --- ------ XAPPLICATION FOR SANITATION PERMIT Permit No. _o- - -- -- -- - --------- - ----- w� I (Complete- Duplicate) ------ This Permit Expires 1._Year From Date Issued .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 LOCATION__-- ----------- ---------- -- jr.... • ---- ----• Owner's Name--------------� � � ll.��-- - - - ---------- ------ -- --- --------- -- Phone---------------------•- Address -------------=------ ------------------------------------------ ---------- Contractor's Name------ • • - - LT Apartment House ❑ Commercial -.- ._----------------------------------------- "--Trailer - --" t - "` Phone--".__.____._ Installation will serve: Residence - ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-{--_ Number of bedrooms -- _ Number of baths __ _ --- Lot size ct. 1 Water Supply: Public system �-- Y Community system ❑ Private ❑ Depth to Water Table ------ _ ft q Character of soil to a depth of 3 fee+• Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam Previous Application Made: (If yes dote__._._.____.__.- C;---New y ®Clay ❑ Adobe❑ Hardpan p - a No �.r New Construction: Yes [�d'o E] FNA/VA: Yes ❑ No [�]-� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------:r7 -Distance from foundation--- --------------- O r _ ®� No, of compartments...-_-.-_ CPK.. -J _Li Liquid de th --Mat rial t Cr43' .ucr ze- Disposal Field: Distance from nearest well " q p . Distance from foundation-__-t-2/-..--.Distance to nearest Io�Gne___.s� ___f_ Number of lines---..---_-" -. : Length of each line---=---=., r_----- Width of trench.----- .-----•----- Type of filter material.-" �._-------Depth of filter material... _-"_,_--_Total length-__ rlC Seepag .Pit: Distance to neare t well_-:__r Distance from"foundation- _:.-=---„Distance to nearest lot line--- g __----- Number of pits--. .___-- r___.Lining material.---__--_i/.... Size: Diameter_ x�. -pepth_.-----/-�---- # A Cesspool: Distance from nearest well ------ ---------------Distance from foundation.___------------ ..Lining material- - El Size: Diameter- -- --------- ----- --- -----------Depth------------- - = Liquid Capacity---- ----- --gals. Priv ---_----•- Y� Distance from nearest well-, ----- _ __ Distance from nearest buildin ❑ Distance to nearest lot lire-.- _--- g - ------------------------------- --------- -------- --------------------------------- ----------------------------------- ------------------------------------ Remodeling and/or repairing (describe)--------------_--- - ------------------------ -•------•-- fi - ---------------------------- - - -----------------------•-------- ----------•------------------------------------------------------------------------------------ --------------- -------- 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 tir (Signed)-- �- ------- By: - .. ------------------------- -----------•---------- ---- ------ ---- •---- caner and/or Contract -Io d/o or) _ -- - ----- --- -------------(Title)--------------- --- ---- ion ------------- - -- Plot plan, showing size of lot, location of Sys+ - re }ion to wells, buildings, etc., can be placed on reverse side). y F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. .- _--------- _ -- ----- ---- REVIEWED PERMIT IS -- E .- ._-- - ------- .--------- DATE_ �---�---~--P-------- BUILDING PERMIT ISSUED............. t --- --------- --�. =-�... DATE- Aiterations and/or recomiriendations:-__.. `� .-"_______________ -------------- ---------------------------- ------------------- --------------------------------- -04-e-- ...... ----- - ------------------------------------- - ----- - ------- --------- FINAL INSPECTICN BY:--------- -- ----- _---- - Date.. .-- - - --------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West 9th Street E.H.9 2M 1.67 Vanguard Press Mantec°•California Tracy,California