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r'UK UVt-[(-t USE: --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 421C;24..W./ ----------------------------------- --------------------- (Complete in Duplicate) --------------- -------- --- ------- This Permit Expires 1 Year From Date Issued Date Issued 7 =- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tho k er ' crbed. This application mads, i milli ce with Count in n e No. 544. �` JOB ADDRESS AND LOCATION _ �i_ may, Owner's Name-- --- -----�,�� ---------------- --------------------------- Phone-------------------------------- ---Az Q /�, ------------------------- Addressr- � .--f-�-----�•�/'='�s/'7 �i ' /s --------------•------------- ---------•--------------------------- Contractor's Name------------/� .lL! � l ----------------------------------------- ---------------- ------------------ Phone.---•---•-----•---------�--- - ' Installation will serve: Residence Apartment House [:] Commercial E] Trailer Court ❑ Motel p Other ❑ ' Number of living units: --t/_ Number of bedrooms 5__ Number of baths _I--_ Lot size _0,`1VC4 Water Supply: Public system ❑ Communitysystem y stem ❑ Private Depth to Water Table �W ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan 9— Previous Application Made: llf yes,date-.._---------------) No New Construction: Yes RR--Tlo ❑ FHA/VA: Yes 4—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publics ewer is available within 240 feet.) Septic Tank: Distance from nearest we ---ZO------Distance fro foundafio _- _- No. of compartments.._- Material- �— q p -'' Size i uid de �h ---- ------- Capacity-/f e�.--- , Disposal Field: Distance from nearest ell._- ��-----Distance from foundation.-,-,Q_--_---.Distance to nearest lost, line_ �C Number of lines-------- ------ of each line-_la69-------------Width of trench-�----__----.--__---_ Type of filter materia _ Depth of filter material----��y---Total length_A. •_______________ f � l Seepage Pit: Distance to nearest well.- f0 - Distance fr foun ation_- ----_--.Dist to nearest�Igt e-f -__ 011, Number of pits _-----------Lining material_— ---_Size: Diameter.--, r--_-----Depfh_s� ........ ❑ Distance from nearest well-----------------Distance from foundation-----__------_--...Lining material---.-- _--._-- _--- P ess oo : Size: Diameter---------------------- ---------------Depth--------------------------- - ---------------------Liquid Capacity- ------------ ----------gals. / Priv y: Distance from nearest well__ ----------------------------------------------Distance from nearest buildingr ❑ Distance to nearest lot line-------------- Remodeling and/or repairing (describe):---------/-VO.4__- --------------- ------------------------------------------------------- -•-------------------------------------------------•---------- ---------------------------- 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. (Signed)- �� -------------------------------------------- ----------- ------ --- -- - �'�� -- --------------- - - [�.,�^,,,�' '~a.,w,; Contractor] By:--------------------------------------------------------------- (Title)-- (Plot - - -- - - - r -- ------------------- plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------ ---------------------------------------- DATE---- -- - - ---- - --- - -------- ---------------------------- REVIEWED BY----- --------------------------------------- ----- ----------------------------------- DATE- -------------------------------------- BUILDING PERMIT ISSUED---------- ---•------------------- --------- DATE------------------------------------- - ------------------------------------------------------- ------------------------------------------------- Alterations and/or recommendations:------.-------- ------ --------------------------------------- ----------••---------•----------------- -------------------------------------------- ----------- ----•------------------------ --------- ------------------------------------------------- ------------------------- FINAL INSPECTION BY:----. // Date .-~1- .. _ SAN JOAQUIN LOCAL HEALTH DISTRICT ,t 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4 Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.