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FOR OFFICE USE: k C APPLICATION FORs°SANITATION PERMIT Permit No. :...1. ? ------- -- --- -- ----------- ------------- ---- . _ --------------------- ---------------------- --------- (Complete-in Duplicate) i. ......................__.._.__..._-- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION ' �� =!•-- ----------------------------------- Owner's Name--- Phone --- ------ ' f Address--------------- t - --�-- -------'-------•------ Contractor's Name------ �� .._.'-' 1 Phone `l Installation will serve: Residence . Apar4ment Nouse [] ~Commercials❑ Trailer Court ❑ Motel ❑. Other ❑ Number of living units: _j-----f Number of bedrooms, 7z___ Number of baths-A-- Lot size _____ ___ _________________ ________________________________ Water Supply: Public system ❑ tommunity system ❑ Private JU Depth to Water Table ______ _ ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_- ------- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ A .:TYPE�OF=.INSTALLATION_,AND SPECIFICATIO.NS:_,,,;.:' -� - ; (No septic tank or cesspool permitted if public'-sewer is available within 200 feet.) " F r Septic Tank: Distance from nearest weil_1g0/Distance from foundation---�a. -_ --- Material.-------- -"-'------------'----' - ---�--� Li uid a th- -A_,6"i('1 Capacity ® No, of compartments------.--ar�--------------Size-- - -•--'----•---- G P. A Y--- r - � Disposal Field: Distance from nearest well-YAAWDistance from foundation- D Distance to nearest lot line-.-._-_--______- I Ell Number of lines! ------------------Length of each line__ _____6 -----------------Width of trench-.-v°- . ___ _______. I Type:of filter material._- /_ ._.______-Depth of filter material.__. .Q� rrg 'Total len th-... f �___ ' C � --------- Seepage Pit: Distance to nearest welL___�.J'� istance from foundation__R0 ___ Distance to nearest lot ® z r iline-_._-._._-___.._ Number ofPits__1 ..�'--'-- -__Lining material__-.._ -_-._.--- -' - Size: Diameter. ��k-i1�h ;I �epth_.--f-��- ` j. .____-__ Cesspool: Distance from nearest well ________________Distance from foundation....___._.___ . _.Lining'matenaf-.--_--_-____._-.._.__-_._____-______, ' ❑ Size:.Mameter- -- --------- --'-- ----- ------- --DePth- --- ------------ ---------- ' ' ----- ------ Liquid Capacity-------------------`---------gals. Privy: Distance from e'arest.well--------------------------_------_---___---------Distance from nearest building----t-__.----------.----------. . ❑ Distance to nearest lot line ---------------------------------------- ------------------------------------------------------ ---------- --' .................... + Remodeling and/or repairing (describe): y. T-----------.". -----, "..M -------- ------------------•-------------------------------------- --•------------•---- ------- ----:------------ --'- i----- -----------=- ------------------------------------------------------------—-------------------------------------------- ---------------------------- ------------------------------------------------------------------- ------------- ----------------------- ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and-rules and-regulation's-af thd"San Joaquirs-L6�al-cal _. k (Signed) �f y C� � ?? _ -- -- ------------------ --- �. -'-'-'-'- ............(Owner and/or Con+rector) - .� BY ------------------------------------------------- - - -------------- (Tifile')._ _.. - '- -� `- -- ..... (Plot plan, showing size of lot, location of system in relation to wells, buil fags etc., can be placed on reverse side). 1 FOR DEPARTMENT,6SE ONLY APPLICATION ACCEPTED BY !. ---------------------------/------------------------------------- DATE ----- REVIEWED BY------------------------------------1-- DATE-------- ' --- �--'-'- ------'-'--------------'-' ------- ---------------'------------ -- '- -----------•---------'-------------'--------- ---- BUILDING PERMIT ISSUED-------------- --------------•--------------------------------------- DATE--------- ----- Alterations --- Ale - o - - -.or recommendations...-'-'-'-'-'- ---- --------------------------------------------_------------- ------------------------------------------- Alterations and/ - kl/ ��l-lht�r------ �y0------F-X1StTl-f1[_6------41917 '11�t_ ....0F -I SP Int�3 .-- hlS .__._ V� �. A cid' x_.u_ 5 -----N- - .__.._.0 K- ------ -- 7n-(0' TQ11� P -_- - --------------------------------------------------- -------------- ---------------------------------- FINAL INSPECTIONBY Date. ' ' a SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California �,_ tonteca,California Tracy,California , E.H.9 2M 1-67 Vanguard Press.