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r-UK OFFICE USE: —� ------------------ -----------------l1:--'*...... --------------- APPLICATION--FOR -SANITATION PERMIT Permit�No. ................`5~`� ----------- #> s '.--------------•--- --------- (Complete-in Duplicate) ----- --- 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 -------AR.4.d31-------- )-----. ------------4�1 ------------------ ----------------------------------------------- Owner's Name ------- r.2 .------ Phone..-------------•-------------------- Address-_. -- •-- ----------••----------------------------------- -----------/-�-------------------------••---•- Contractor's Name , ------------- Phone-_7l _-Ar/!;/Z..-- ---------- Installation /Z..-° Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: -/__ Number of bedrooms e.- Number of baths -f- Lot size ----a'S,X /;7 r R - ---- Water Supply: Public system [Community system 0 Private ❑ Depth to Water Table 4r� ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam 0 Clay ❑ Adobe ar'Hardpan ❑ Previous Application Made: (If yes,date_................_ ) No [Er' New Construction: Yes ❑ No [< FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: Distance from nearest well-----------------Distance from foundation----------------- Material -------------- _-_----_- ❑ No. of compartments------- ----------S;ze-------------------- -----------Liquid depth--------- ------- --------Capacity---------------- \3 Disposal Field: Distance from nearest well 7)074_Distance from foundation--_- _Q.i-._...Distance to nearest lot line ivZT-_ -.._-- Number of lines ----/___________ Length of each line-- -3a.................Width of french------.�_�f_ ---.--------.- Type of falter material------ S - i----Depth of filter material-___--/_$_-___Total length--------3Q--------------_----.___-_- Seepag , Pit: Distance to nearest weft_ foundation---- f_.-.Distance to nearest lot Eine--.---4r— -_ �e lli�%-----Distance sta nce{{f��rom Number of pits._- __/-------------Lining material--11. _.- 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-------------------- ❑ Distance to nearest lot line ------------- --------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------- -- ------- - ---------- --------------------------------------------------- ----------------------------------------------- ------------ --------------------------------- ---•-------------------------------------------------------- ---------------------------------------------------------------------------------------------------- - 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 ruI s :dpegulafflons of the an Joaquin Local Health District. s � (Signed) - fibs' (Owner and/or Contractor) Y 8 f .•--[�t.l - ------------ (Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- DATE REVIEWEDBY--------------------------------------------- --- -------------------- ---------- -----------------------------•-------- DATE---- ------------------------------------------------------- BUILDING PERMIT ISSUED-------- ---------------------- ------------------------------------------------------- ------------- DATE---- Alterations and/or recommendations---------------- - --------------- ----------- --- --------------------------------------------- ----------------------- - ----------- ---------- ---------------•--------- ---------- --------------------------------------------------- ----------------------- FINAL INSPECTION BY:-_ .-- � ----- --------•------- Date--. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 200 West 9Th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press "