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FOR OFFICE USE: F�� l�l/ tr �- --`------ ----------- --------------- --------- ------ - APPLICATION FOR SANITATION PERMIT Permit No. --- ---------- --- ---------------------------------- - -------- o tom- `% (Complete-in Duplicate) Date Issued -------- -----I......-----________--.----.--- 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• ' JOB ADDRESS AND LOCATION. - _ .� %-N ------;`(ME 5i=----------------------- Owner's Name------ H1--_�—� �� 1 •- �_+ ------------- ,_0 ------•-- " Phone. = Address .0-` •BJ--f? ��t � ---•------------------------------------••----------•----------------------------- f Contractor's Name_.CldNfVE� -----:J?---------------- ------------- -----------------•--- ------• -----------------------•----- --------------- Phone------ -• ---------- Installation will serve: Residence Apartment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y Number of living units: I----- Number of bedrooms__ N_u_mb�r o_f_baths -;.Lot size ---- ----------------- Water Supply:'! Pubic system • Community system ❑ Private ❑w Depth to Wa}er Table ft I 1 Character of soil to a depth of 3 feet- bSS-rid —Gravel - Sand. -Loam g[Q"CIa Loam`n Clay ❑ Adobe [] Hardpan ❑ } Previous Application Made:`;{If yes-* ---- -.') No;t New Construction "Yes' t6-E1--FH,A/VA:'Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { `r Y q �� I p Li u id de th `/ I Septic T nk: Distance from nearest well_- !�"--_Distance from foundation_..__ _ maters, _.. .Q _ _ - --------. No._ of compartments______- _ -.- -- _Size_YX - q P .i ;..Capai�tY---- y� �1 Disposal Field:! Distance from nearest well--.--W_Distance from foundation-----/D........Distance to nearest;lot ®� ' ------- --------Length of each line__ ---- . ---- . g rench.- Number of fines.}� ___-__ g �_-�✓. ___-�-f-----.Width oft Type of filter material-IR0.� --.-De Depth of filter material___/ Total len th____.__..__=__� � -- Seepage Pit: Distance to nearest well...__. -.-_._Distance from;foundation___.____._________.Distance toDea}hst lot Sine------- :......... { I�lumber of pits._. ,..---------------Lining material-----.!___-_.. Size. Diameter------- p !. { ❑ ' Cesspool: -' i Distance from nearest well ----.___.__.__Distance fiom foundation_.:............. ..Lining material_..._.______._.___.__._________..__. ❑ i Size.: Diameter- -------------------- Depth = ------------... Liquid Capacity----- ----------------------gals. ("•`,i INPrivy: ( Distance from nearest well------------------ ------------------------------Distance from nearest building,---__-_-___--_____--______...-..-----. ❑ s Distance to nearest lot line ......................_._ - ------ ------- ----- , Remodeling an"d/or repairing (describe)-A---------------- -------- ----------•-------- -°------------------------- ------ ------------ - _ _�..= - _- — --� =- --------- ---------------------------- :: i------------------•--------------------------------------------•----------------------------------- ----....------------------------------------'_-.-------'---- - I i hereby certify that I have prepare this application and that the work will be dans in accordance with San;Joaquin County ordinances, StAte laws, and rules and regulations of the San Joaquin Local Health District. Al �� (S fined} �� ._ „_Contractor.� v-------- ----- _. ._r (Owner and/or `f ----------------- - -------- -- -- ------(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 } APPLICATIONACCEPTED BY------- + - ----------- ----- ------------------`----- --- ---------- DATE------ -----3:-.- -------------------- REVIEWEDBY................... -------------- -- --------------- ------------------------ BUILDING -- ------------------ = DATE----------- --------------------1---------------------- ` BUILDING PERMIT ISSUED-------- -- -- ------------------ _ -- -------------- DATE----------------------------- -- ------------------------- A.-------------.---. Alterations and/or recommendations:....__: . .....B�7ib ;=------------------------------------ - ----- ------------------------- ------- S, Date---------------- -3©- FINAL INSA� -6. t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California 1 Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press — �.