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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 'Z...........�...-.....3 -------------- ---- ----------------------- ----- -- (Complete-in Duplicate) Date Issued --- 4,7 _................ ........... ----------.----------.------ 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 LOCATION. . -- -._ = r.- ' �� ) Owner's Name.---- - ---------•--------------------------------- - ---------.--- Phone.. .. �-.3 7J�� Address.. 102-45---- -�•-- - --- a� ------ ------------------------------- ------------------- ----------------------• •- R , ------------------------------- ------------------------------------------- Contractor's Namef�� Phone... --- - Installation will serve: Residence $ Apartment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....-.- Number of bedrooms Number of baths.vim..... Lot size -0-:-AA-21-------- ------- � Water SuPPIY� Publics stem ❑ CommunitY system Wiv�ate ® Depth to Water Table .7 ft � Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑\Sar�dy,LoamO Clay Loam ❑ Clay ❑ Adobeg] Hardpan j� Previous Application Made: llf yes,date------------------------- ) No ❑." New ,Construction: Yes ❑ •No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available witRin 200 feet.) _. ,t , Septic Tank: Distance from nearest well_e_Q--. ---�7ista c from foundation---/O-....... . Material.. ------------ ® No. of com artments...- .....Size _.. . __ +_..Liquid depth.....------. --------Capacity-_1,�r ------- Disposal ------ f p "" : Dis osal Field: Distance from nearest well_e ------ istance from foundation.-__...O----.-...Distance to nearest lot line-/O.._.----. Number of lines ----- ..A------------------------Length of each --------......Width of trench..214y.'r--.... Ry Type of filter material,0.,1'1��.............Depth of filter rrl-terial---� __`"-______Total length---;L. ------ ------------------ Seepage Pit: Distance to nearest wellIft----------Distance-from foundation.--/-AnQ'_. Mstance to nearest lot line--+ ..---_-... xNumber of pits...,2--------------Lining material- �,•,,�____._ Size: Diameter..... ..!.....__Depth-,P-410------------------- Cesspool: epth.. 10------------------- Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-------------------------------------- EJ Size: Diameter. ------- ----- ----------------Depth---------------- ------------ - - - - ------------..Liquid Capacity- - ---------- -----------..gals. Privy: r ' Distance from nearest well-------------------------- -- __........._..Distance from nearest building---.----------------------------------- .-. ❑ Distance to nearest lot line ---------------- ------------ ----------- Remodelingand/or'grepairing (describe)---------------------------------------- -------•----• -•---------- ---------------I------------- -------- -r-------------------•------------------------ -- -- ----------------- ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- 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. C(Signed)------------ ----(Owner and/or Contractor) By (Title)_ ------------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I$ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- --- - -- ---------------------t------------------------- -------------------- DATE.- - --/,5 -rte_7------------------- REVIEWEDBY ----------------------------------------------------- DATE---------------------------------------------- - BUILDING PERMIT ISSUED-------- -- - ------------.._ -- I------------------------- --------- DATE------ ----------------------------------------------------- Alterations and/or recommendations:.---, �p �~� -� � - ��-.. a��' � �'' l�� ---------- ------------- ------------------------- - - -------- --- -- r FINAL INSPECTION BY-.. -------------------- Date---7— —AY-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 405 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California E.H.9 2M 1.67 Vanguard Press