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FOR OFFICE USE: --.//=-/-G-7--._-..______ __ ___ _ ' APPLICATION FOR SANITATION PERMIT Permit No. �;2 V (Complefe•in Duplicate) - This Permit Expires 1 Year From Date Issued , bate Issued Application is hereby made to the San Joaquin Racal Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. -' JOB ADDRESS AND LOCATION__----- C Owner's Na --•--£/-- -1 /L,� ! ------------•---•---------- ------- ---._... ------------- ..) Phone___`�..f2 --� /- Address � __f-,Z-(�_. .. f -------------------------- --------------- Contractor's Name_.___--��zC __------- �,/ ----------------------------- ----- ------ --------------------------------------------- Phone------ ----------------••---------- Installation will serve: Residence 12 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ----- Number of bedrooms _ ___ Number of baths __/_ Lot size ___. • Water Supply: Public system ❑ Community system k-"Private €i„ . Lf� ❑ Depth to Water Table ._..__�i•t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ San Loam ❑ ClayLoam CI- 15 ❑ y ❑ Adobe (C� Hardpan ❑ Previous Application Made: (If yes date--------------...." ) No New Construction; Yes ❑ No Eli[ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i)i (No septic tank or cesspool permitted if public sewer is available within:200 feet.) #I' l - Septic Tank: Distance from nearest well___3 -----Distan fro -foundation" " ._ . ._``? �C��- Materiah, _�.�:.�„ No. of compartments._.__.. -.---___-.-.Size--------X_ -- ______ Liquid depth _._ ... . ------ acit f -- -- p Y-•e _� ``+ Disposal Field: Distance from nearest well-. . C�_---Distance from foundatiop "-�--C�--•-"-_Distance to nearest lot line--'-15____- Er Number of lines-_�___ _ Length of each line__ _.. __( •r ----- �� Width of trench--- �---� Type of filter mat rial-- _Depth of filter material----1_7_-____._Total length ----- -----------•- ......................... Seepage Pit: Distance to nearest weli....f.LS_-.C?__- Distance from oundation__-,l_4�__�---.Distance to nearest lot line__.__ _____ Number of pits--- .:.�_------___Lining material," Size: Diameter___________ Depth_.__- ____-_ Cesspool: Distance from nearest well _..-------------Distance from foundationL Filling material-_._..______________-____________-:_. El Size: Diameter_ _- I ----------- -- ----------------Depth -- ---------- ---- -------- Liquid Capacity- -.-.----------------------gals. Privy: Distance from nearest well... _-Distance from nearest buildin ❑ Distance to nearest lot line ....._._ ---_ u g-------------- --------------- ----------- Remodeling and/or repairing {describe):_____. ----------------------------- --------------------'1 ____"-___.___.____4--------_ - ----------------------------------------------------------------------_ ________________________._._ _________________________________________ -----------------------------------------------------_------------------------------- ---------------------------------------------------.____.--------- 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, /� � Z (Signed) -S 1.- ---- ------- r ---(Owner and/or Contractor) r - --------------- ------- By:-------------------------------------------------------------------- --------------------- ----------------------------- - -----(Ti+le)------- -- --------- Pot plan, showing size of lot, locationiof system in relation to wells, buildings, etc., can be placed'on reverse side). t _ OR EPARTMENT USE ONLY APPLICATION ACCEPTED BY-_._.__.____ - _ DATE___ - -` '—'- _ ---------- ----- ---- - / - --_-- ---------------------- REVIEWED BY ---------------- --- DATE------- . BUILDING PERMIT ISSUED DATE ----------------•----------- ------------- - Alterations and/or recommendations:__-._ `+ ` ---- -- - p--------- - - -C � . � ----------------------- ----------------- --------- -------- -------- - -- ------------------- - i FINAL INSPECTION BY--------R,� _. ------ Date---JQ� UIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street - 205 West 91h Street j Stockton,California Lodi, California Manteca,California , /j TracyCalifornia E.H.92M 1.67 Vanguard Press _ � ,