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FOR OFFICE USE: OOC( i 1 :2- 10 ____.............___._.___ I--___-_____--.,__---.. APPLICATION FrOR"SANITATION PERMIT Permit No. . ......__............. ------------- -------------------------------- ------ (Complete-in Duplicate) Date Issued ..�_�s3_�v_� --- -------------- ---_ -----.----.._-- ____---.------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to onstruc and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__-. ------------ Q (/' Owner's Name_ % :z�. ,at..___ i.,Q___. ` ��' ------ -------------------------------- Phone__ �S,�K�!_G.--------- - ... - -- ---- -- -- �� _Address.... c.,. -------------------------- -------------• --------------------------------------------------------- ........................................... Contractor's Name--- _ `- - ter �' � 1_.-, e: --- ------- --------- ---------------------------- Phone---------------------- •---------• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: •_!__ Number of bedrooms -------- Number of baths-./-__ Lot size ----- -- . � _______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __.___ . ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam P Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If 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 within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -------.---------._-..___.________-._---_.____.- 171 No. of compartments------- ------------.__-Size------------------_-----------Liquid de th__--.--- ------- - Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---------------_- ❑ Number of lines----------------------------------Length of each line_- ------------.--------------Width of trench-_-_-_________--___--._-_____-__ Type of filter material------------------------- of filter material-----------------------Total length__________________________________________ See e Pit: Distance to nearest well-- ;4 -Distance frgm fouhdation___.,/47`___. Distance to nearest lot line%S._ Number of pits_.. _._--_ Lining material_____ _ ,,,- Size: Diameter-----------------------Depth /4-4.1/'_ x 'Ste pool: Distance from nearest well _______________Distance from foundation----------------- Lining material___ ❑ Size: I2ianaet��..___ _ __-- -.8e tk1-,- =� - Ga"'City --------- -- -gals. Privy: Distance from nearest well-------------..----------------------------------Distance from nearest building------_----------------------------------- -- Distanceto nearest lot line-------- ----------------------- -------------------•----......----------•------•--------------------•-------•-----...------_---•-•-------- Remodelin and/or repairing describe :___-.._._- / ---•------•----•------------------------------------------------------------- --•-----------------------•--------------------------------•--------------------------- ------------.-----------------------•--- -------------•-------=--------------------------=------------------------------------ ------------------------------------•-•-----------------------------------------•----------------------------------•---------- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County cg ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------ - - --- •- -- ; s- �- -~= ------------_--------�------ - ---------- --- -- --------.(Owner and/or Contractor) �r By: :: 2=4 :,' ----- y• �- - ------------- - ---- ---------------(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 -------------------------- -- ---- ------------------------------ DATEIS-C--7 ." REVIEWEDBY-------------------- -----------..------------- ---- ------------------------------ ------ DATE BUILDINGPERMIT ISSUE ----------------------------------•---------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------___----------------- ------------------------------------------------------------ -•--•--------------•-•------- --------------- ------------•-------------------------------------------------------------------------- ----------- ------------------------------------------------ -------------- .-------- ------------------------- -•------ -------- -----------• ............ FINAL INSPECTI BY:-- ----- - --- ---- - ----------- Date-- ._--------- ? -. - 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 E.H.9 2M 1-67 Vanguard Press _