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FOR OFFICE USE: n r�r' � 110"f ------------------------------ ------- APPLICATION FOR SANITATION PERMIT Permit No. . - . (Complete•in Duplicate} ----------------------------------- ------ ' -. -._ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local H6alth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 7 - n JOB ADDRESS AND LOCATION i ........... 1ST f b .X�1lJc --------------------- ------ Q _. Owner's Name-------------- 1 1 L-LI_P.��?------- _ l�C7LQ Q ----------------------- Address------- ------ --------------- Phone_.._.. Address /gL1Y]A r� ,�.CV�.. p -------------------------------•----------•--------------------- Contractor's Name....MRS ------Fw__ -a_p ---------------- ----- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j._.- Number of bedrooms J--- Number of baths_/._._ Lot size ----j+9. Qao g------i-—-------------------- Water Supply: Public system E---C,.Immunity system ❑ Private ❑ Depth to Water Table /3_ ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date_---------------- 1 No E--' New Construction: Yes a_ o ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Perm1 fed if public sewer is available within 200 feet.) _ Septic T nk: Distance from nearest well--C__—Distance from foundaUon----1 -----------Material . ()��-4R-F-T.lF-............ - No. of compartments--_. .............Size___ _X_`a-�S__.___Liquid depth___ .__ Capacity___.=_/�-�'b-- Disposal F' Id: Distance from nearest well...G-.W_Distance from foundation____f __..._...Distance to nearest lot line___.-__________ Number of lines _____-__ —________________Length of each line__ ____ ___ __.___._.Width of french_____...._-3-6...._________. Type of filter material.__9VCK__Depth of filter material___--- _ Total length____________________ __ Seepage Pit: Distance to nearest well_________________-----Distance from foundation_.____-_-______--.Distance to nearest lot line__________.-_____ ❑ Number of pits--- ------------------Lining material------.--------- - --- Size: Diameter----------------------:Depth--------------.-----_-----.-_.-_ . Cesspool: Distance from nearest well _.___.....-.-_Distance from foundation------------~---- -.Lining material-_____________________________________ ❑ Size: Diameter- -- -------------- ---- -- -------Depth--------------------------------- -- - -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_____----------.___________---___________._._Distance from nearest building__--_-_._________-__________------- _A ❑ Distance to nearest lot line ..:::__..------------------------ ------ - ---- ----------------------r--.--,.---------------------------- --- ------------------------- Remodeling and/or repairing (describe):----------- - -•---------- ----------------- ----------------------------------------------------------------------------------------------------------- I------------------------ - i 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. t ...---. --- ..----- . - --------------•----- ---- -- ---------------------Owner and/or Contractor (Signed}----------------- --- - - ( / ) _ - e (Plot plan, s owing s of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). J FOR DEPART NT USE ONLY x APPLICATION ACCEPTED BY---------- �> -------- - ------ ------------- -------------------------- DATE-----------7-----7r- = REVIEWEDBY----_-------------------------------------------------------- --------------- --------------------------------------- -- DATE------ ---------------------------------•• - -------------- BUILDINGPERMIT ISSUED-------- ----------------------- - ----------_--- ------------------------------------------- DATE----------------- ----------------- ------------------------ Alterations and/or recommendations------- --- ------ ---- i e FINAL INSP .-- - .. .------. Date ,ll�.'_ �__�`. SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stoekton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press