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` T FOR OFFICE USE: jwn/7--�-4/-r------- -------- ---.�` APPLICATION FOR SANITATION PERMIT Permit No. „_-_.----- (Complete in Duplicate} Date Issued --1�---/-•--� ----------------------------_-- 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 descrbed. This application is made in compliance with County Ordinance No. 549. A JOB ADDRESS AND LOCATION_..�__,?-. ----------------- -------------•- ------------ - - � � ----------- -- -- Phone-------------------•--------•------- -------• -------------------- ------ -10 Owner s ame- • Address. - Q' IaPhone- - • Phone --11411%711(1 - - --------------•--..--. ------ --- -----Contractor's Name_.__ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer, ourt ❑ Motel _❑_ �Other ❑ Number of living units: __ _.___�Number of bedrooms _..____ Number of bath s o size _._. --•----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table-Vo- ft i Character of soil to a depth of 3 feet- Sand F] Gravel ElSandy Loam [IClay Loam E] Clay ElAdobe jg Hardpan E] Previous Application Made: {If yes,date--.----- } No� New Construction: Yes ❑ No FNA/VA: Yes E] No El I TYPE OF INSTALLATION AND SPECIFICATIONS: i ONS: 4,744a,,(No septic tank or cesspool p4,miffed if public sewer is available within 200 feet.)Se tic Tank: Distance from nearest well-7).d tZ-Distance from foundation_- --U---._._-_ Moaterial. ______________ ___________________________ P r • No. of compartments_.._.0�-------------- Size_3,X�X� -----------Liquid depth------ - ------ ---- Capacity-- 40. x 1 D --_-----Distance to nearest lot line_$,_______.. Disposal Field: Distance from nearest well_ QYL .Distance from foundatpion_?__ ,, Number of lines'--1---- -------.------------Length of each .line__.-%v-.------- ---------Width of trench...._��.-.__________________ Type of filter mterial__ _9 --------------Totalength----.--.-�-- --.--I Spr�---Depth of filter material-./ G -------------�------ I ' �-Q_.___.Dista'p to nearest lot line..gr______-.- Seeps e Pit Distance to nearest well--W.04-.__Distance from f undation__ ----_-.--Lining material._ -- Number of pts'__ _ Size: Diameter.' .----- --- Depth____-G .S____________________ ' Cesspool: Distance from nearest well ________________Distance from foundation_------.--------- ..Lining material-----------------..----------------- r� ❑ Size: Diameter- -_ p Liquid Capacity ________________________ Privy: Distance from nearest well._.___.--------.._--------._._..._. ......-. _..Distance from nearest building-------------------------------------- ` ❑ Distance to nearest lot line---------------- ---- Remodeling and/or repairing (des Iribe):---- ---- - - j ----- --------------------•- - ' ------------------- -- ------------------------------- } .. ------ ------------------------------------------------------------------------------------------------------------------------------------------------- ---------- I - - t 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 ..__. ��.._. . . -- ___ and/or Contract (Signed - -- - --------- ----- ----------- By:-------------------------------------- L� (Plot pian, showing size of lot, local on of system in relation t els. buildings, etc., can be plated on reverse side}. FOR DEPARTMENT USE ONLY dCDATE- -/f` ----------------- APPLICATION ACCEPTED BY_r - - REVIEWEDBY BY----------------------- --- - ----- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED-------- ,] DATE -- ----- q. p - � ------ - Alterations and/or recommendation :_____ .!._.-_.-_--- `--- .?C---�S ------- -- ----- •------- ------------------ --------------------------- I ----------------------- ---------------------------- Ir� _ ! --� FINAL INSPECTION BY: r'. ----- Date --- -� r r _.. �------------------------------- 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 I E.H.9 2M 1.67 Vanguard Press