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rVK UrrK t Uat: --------------------- ----------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No, o2.c �. ----------------------------------- -------------- ------ (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 Ori ce No. 549. i � 5 IVB I E - JOB ADDRESS AND,LOCATION.._ "- -" " v' Lv)- f Owner's Name = -------------- Phone p ------ � t ------------==-------- 7 2 -------------------------------------------------- Address------------------------- Contractor's Name------ Phone___" !f' Installation will serve: 4Residence Apartment House ❑ Commercial / El Trailer Court E] Motel ❑ Other E]Number of living units:••___L.__ Number of bedrooms _._ _ Number of baths P_Y2.Lot size --__--40 ,- Water Supply: Public system..❑ Community system ❑ Private Depth to Water Table 1.9 ft. Character of soil to a depth of 3 feet: Sand ❑ Graves ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe ❑ Hardpan ❑ € Previous Application Made: (If yes,date.............:....... New Construction: Yes 2"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS ..(No septic tank or-cesspool-permitted�if-publicsew.er.is available=within..200 feet:) w Septic Tank: Disfance from nearest�well:_IPQ_-`' Distance from foundation___ _ -----------Material___.__ "- f No.' of-compartments--------- -------- Size---./ x_r -- --Liciuid depth----! .---� 4L -------.Capacity. t _ ©---- Disposal Field: Distance from nearest pis ante from foundation.._u°l � ` _.__._..Distance to nearest lot line---t5---__------- �} ' Nui`-hbe; of lines___.------ 3____-__-------------Length of each fine-___ _ g ----- �;-------..Width of trench---- - -------- �------------- \ Type of filter material !," ®- Depth of filter material__-_/__V___"-------Total length-______..`a--------------------------------- ----- Ld Seepage Pit: Distance to nearest well___-------------------Distance from foundation------------------. Distance to nearest lot line-_.----.__.___-- [� ❑ Number of pits--..__._.____..___._Lining material____- ---___,__.Size: Diameter.__"............... . Li l - Depth--------- -------------- � Cesspool: Distance from nearest well.--.___-_.._-_-_Distance from foundation__________________.Lining material------------------------------- i -� ❑,,. _.,� .�ySize: Diameter, - - - ----------Depth-------------- ----------- -----------------------Tz Liquid Capacity-. -------------------------gals. _ .... Privy: Distance from nearest well--------- --------------Distance from nearest build ng ---- --------------- ---- ❑ Distance to nearest lot line________________.________ - Remodeling and/or repairing (describe)_-----------------------------_____.d_--------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------•---------------------------------------------------------------------------------------------------------------- --------------•---------------------------------- 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. (Signed) ------ ------(Owner and/or Contractor) r 13 (Plot plan, showing size'of lot, location of system in relation ta.wells, buildings, etc., can be placed on reverse side). FOR DDfi ARTMENT USE ONLY APPLICATION ACCEPTED - - ------- ------------------ -------------------- --------------- - DATE----- �� REVIEWED BY ------- ---- ---- DATE ------------------ UILDING PERMIT ISSUE ---------- --------------------------- -------- DATE ------------------------ -- Alterations and/or recommendations:---_-_..______-_.-_____________________ - -- ------------------- -------------------- ----------------------------------- ----------- ------------------------------•------------------------•-------------- ----------------- ------------------------------- ------- ----- -- ---------------- -------------- FINAL INSPECTIO Y:.. _ - -- ---- --------` Date AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellen Ave. 300 West Oak Street 124 Sycamore street 205 West 9Th Street Stockton,California Lodi,California — Manteca,California Tracy,California F.P.0 O.