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FOR OFFICE USE: - --------- --•------...- ----------- p - /__.-- /-- - ; APPLICATION FOR SANITATION PERMIT Permit No. ` ----- ------- - 1� (Complete-in Duplicate) Date issued -.---- This Permit-Expires 1 Year From Date Issued k Application is hereby made to the San Joaquin Local Health District fora permit to construct and install,the work herein described. This application is made in compliance with Count Ordi ante No. 549. fr.Q � f i JOB ADDRESS AND LOCATION-=if-- __-70-• t k Owner's Name.._ .. =�k' ,= '. ..- zw �- � -------- -----. Phone_.-�"�� .�_% 7C-9 Address----- .... 2 `---- ------- 1.0 =-ss: �. r ------------- -----------------------------------•---. Phone._ G? p fContractors Name. ------ ------ Installation ---- �House �ammercial T ii r ri lrrr�❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment ❑ Number of living units: __�__-- Number of bedroo Number 110� Lo size ,� F-: _ - Water Supply: Public system ❑ Community system ❑ Priv ate ,epth r Tablet I Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0ardpan ❑ Previous Application Made: (If yes dote_....__._.-.----_ ) No ❑ New Construction: Yes No ❑ -F VA: Yes * No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,�yy Tank: Distance from nearest well 0_.-.- Dis#a��nce from f a fion._�f�.........-Material`mow- ��----------------- Septic�o'"' x•'No: of compartments_ r_--_-___ Size �f�'^ Liquid depth- •/ p st well ...._Distance from foundation..- _. Distance to nearest lot Irne----.,�__ :.... Dis os I Field: Distance from Weare Number of lines r . -.___....-- Length of each line.. _. -..-.Width of trench...-�� _�� ------------- Type of filter materialo , _. _Depth of filter material..... -�f-- Total length--_._.-.l4?`_r_! -_'_______________ alb _ ' � r� � Seepge Pit: Distance to nearest well-.-. - -Distances rom oundation--- ,. --- Distance to"nearest lot line--- -- -....- Number of pits.-- _ Linin material.l:� '_ _-_... Size: Dieter..... .�� '`De.pth=. .............. „ p . g �-f�� .. ; . Cesspool: Distance from nearest well ....._--.......Distance fro foundation-.-.- ..._:.:-Lining a eriaL.-__._-__-..� .............. ❑ Size: Diameter. . ----- ---- ----------Depth----- _ �------- - --------------Liquid Capacity --------------gals. Privy: Distance from nearest well------ ------- ------ D sta fr ea rest building_=-;_w. .--_-.....----.- -------------- - ❑ Distance to nearest lot line ------- -- ''- -------- = t 7 t6f" ' Remodeling and/or repairing (describe)':----- ------------------ ------- - ¢ _ `: - ----------- - ---- ''-------- ''---------------------------�------------------------------------ - - ----------------------:----------------------------------------------------------------------- ----------------------------------- - --- --- ----------------------- -- -- 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 .'--- -- ------- r ` , � -'r Contractor) [Signed)-- --- - - { f :�'` - =- ------------(Tit{e)------------ ---- ---------- - - - -- --- ----.-... BY:-------- - ------------------------------ -- 1 -- (Plot plan, showing size of lot, location of system i. elation to wells, build gs, etc., can be placed on reverse side). F R' EPARTMENT USE ONLY f � APPLICATIO�NAGCEPTED 13Y___.-,_-- DATE.._ fi.�, . f I REVIEWED BY -----_----------------- DATE BUILDING PERMIT ISSUED. - . - -- ----- . .. ---- - --------- DATE Alterations and/or recommendations------------------- -------- -------- ---- ------------- ------------------------------- ------- -- ------------------------------------------- i --- -------------------- ........---------- I [ r Date....- 1 =1' - - FINAL INSPECTION BY:_--_. !.� �...^4 'v � - 44 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press I .