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FOR OFFICE USE A ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...-f-.-D_.,l--Q_ ---------------------------------- ---------------- -- (Complete in Duplicate) Y ----------- 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 OrdinanceN . 549. JOB ADDRESS AND LOCATION--� 2 ✓J�(ic/�t Owner's Name =A-tL+-vital---- e-a�'f'� -- -------- Phone Address ----------- •-- •---------------•------•--- ---------------------------------------------------_---- Contractor's Name - c-- �"S Phone Installation will serve: Residence k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.1--- Number of bedrooms _A= Number of baths _I_-_-_ Lot size �6"2'_ey_.�__ ____________ _ . ;- ----------- Wafer Supply: Public system [tom Community system ❑ Private ❑ Depth to Water Table - O ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe �iardpan ❑ Previous Application Made: {If yes,date---------- ----------1 No New Construction: Yes [] No Ez9�FHA/VA: Yes ❑ No [�}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitfed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- ------.---Distance from foundatio1,0__(-_______-----Material-. No. of compartments--__�Z----------------Size-_. X `X_rJ------Liquid depth------- r Capacity--- d Disposal Field: Distance from nearest well ----------------Distance from foundation---&------------Distance to nearest lot line--45____f._-- �~ Number of lines- ___i(_- Length of each line---lpD- -----------------Width of -4�_�'_--..._-------_- Type of filter material-_-(1r�.f� -------Depth of filter material---��'__.. ------Total length-._.--�Q--`______________ �►J Seepage-Pit: Distance to nearest well-.---_�_-_-------Distance �_m,,,,,,foundation----10--- ---_-_Distance to nearest loft line---�-_--_.- � Number of pits-��---I__.------- _Lining material-__�wc----Size: Diameter.__._,3.3_-7- Depth-._Z_iS Distance from nearest well-----------------Distance from foundation.-..-.----------.-..Lining material--------------------------- 1T -------------- Size: Diameter Depth rLiquid Capacity - ------ ..gals. Privy: Distance from nearest well ----____---------------------------------------- Distance from nearest buildin ❑ Distance to nearest lot line------------------------------------------------------------ ------------------------------------------------------ - - Remodeling and/or repairing (describe)--------------_--.-, -----------------•------------------------------------------- - -•------------------------------------------•-------------------------------------------------------------- --------------- --------- ----------- ---- - ----- ----------------••---a---- ------------------ -----------------•---------------------- ------------------ - - -- ---------- --------------- . :C . 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. # 4 - (Signed)-------- ----- - caner and/or Contractor) E By:---------' -_--•- ------ ---- --------- ------------------------------------------------------------------------------------(Title(---------------------------------------- ---------:------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY-- ------ ` ---- -----------------------`--------------------------------------------------- DATE------.REV2-� - 6- ' ------------ IEWG E I IS - - --- --------------------------- ----- DATE--------------- -------------------------------------------- BUILDING PERMIT ISSUED --------------------- ---------------------------------------------- ----------- DATE----- --------------------------- ----------- ------------------- Al+erations and/or recommenda ' ------------------------------------- ------------------------------------------ ---------------------------------------------------------------------------------------------- ------•-------------------- ---------------------------------- ---------- ------------ ---------------- ---------------- -I FINAL=INSPECTION BY:- �.=�=---------- --- ---------Y---- -------- Date---------�---��2 -'-` - 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 F.P.GG. A