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' F OFFICE USE: "T y, _ a __ _ __ ;Cy m. . lM APPLICATION FOR SANITATION PERMIT � � Permit No. ____... IM _...... (Complete•in Du licafe G P Date Issued sF0. 4 -----------"----1p'--_----"............... 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. ADDRESS AND LOCATION/ - � --------------------------------------------------- JOBOwner's Name_. - ----------------- Phone.,"-2- - Z 7 � 1 D►� 11r --------- Address------------I�----------•--•-�---��---*�----- -�---------• - �` --�x=�-=--�------ ------------- ------- �---- - -� --a Contractor's Name------ ---------Z--�1__. __ '�- -- � --- Yhone------ ------ -----••-------.----- Installation will lserve: Residence 9� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �,q Numberofliving units: .---- Number of bedrooms __/___ Number of baths"_/--.- Lot size _.__.�- - ---G ----- Water Supply:{.Public system E] Community system [:1Private Depth to Water Table,.I.'; /ft Character of soil to a depth of 3 feet- Sand Ej Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe 23/ Hardpan ❑ "I Previous Application Made: (If yes,date...... ------------ ) No TNew Construction: Yes No ❑ FHANA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest-.well--- �._..._Distanc from foundation---/ .........Material ----C�;4 ✓- '____________________ (� No. of compartments----_------�----------Size--,/- --- -- -----------Liquid depth--------- ------- --------Capacity...Z Ze?.0 i Disposal Field: Distance from nearest,well-. "E_...._Distance from foundation__./ - Distance to nearest lot line J.._ Number of lines________ .._. Length of each line----------- of trench ... _ ---_______________ ---------- f� ' �`` Type of falter material--_-_.--- � .-Depth of filter material_---,1 -_____."_...Total length---_-.-.---_ ______________ V 5eepa Pit:'. Distance to nearest well.....Z0,17�._--Distance from foundation.-_--Z& .....Distance to nearest lot line:_`_•....`1 • Number of its.-. _- ize: Diameter__-- 2 - -------------- p ------ -_.__Loring material Depth---- ------ . Cesspool-. Distance from nearest well ----------------Distance from foundation................. ..Lining material.----------------------------------- . r❑ �. Size: Diameter- -- ------------------------------Depth----------------------------- -------------- -----Liquid .Capacity--:- -------gals. Privy: Distance from nearest well------------------------------------------------Distance from neacesf_.building:� ----------------.---------.----. ❑ Distance to nearest lot line .------------------- ----- -------------------------- ---------------------------------- ----- ------- // Remodeling and/or repairing (describel-------------- `-------- ------ __�---. __ ____U - f _ -7f�--- �•------ ---•--------------------•------- ---------------------------^------,--------"-------------------------- --------- - ------------ ------- - --- ---- ------ - =--- -- ------ I� ---------- --•-------------------------------------------------------------------------------- -•----------------- ---- -- --- I- ------ --- ------------------ •-------------- ----------------------------------------------------------------------------------------------------------------------- ----------------------- I hereby.certify;that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Daws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- G f <�+ r � - --------- �� n rac orj - (Title)- (Plot.plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed on,reverse side). I OR DEPAENT USE ONLY t APPLICATION ACCEPTED BY DATE ---- --s-� /Y'/_r/ REVIEWEDBYI--------------------------------------------- --------------- -------- ----------------------------------------- ------ DATE--------------------- BUILDINGPERMIT ISSUED-------- -- -- ------------------------------- ------- ---------------------------------------------- DATE------------------------------- --- ----- --------------- Alterations and/o; recommen afiions:.---- ..... e ..�---------------------- -----------------------------•-"-----------------------------•• --------------------- ---- Oppr� ----------------------------- --- --- --- -- - ------------------------------------------ f ----------------------- - ----------------- --- _ - r.t /_ j .rZ.;?c FINAL INSPECTION BY:- ------------ ---------------- ---- ------------ Date ISAN JOAQUIN LOCAL HEALTH DISTRICT 1401 F.Haielton Ave. 300 West Oak Street 1.24 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press