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FOR OFFICE USE: -- -----=------ ------------------------------------- Na APPLICATION FOR SANITATION PERMIT Permit _-_-_-._...__.-_ {Complefe-in Duplicate) a- f licate) Da#e Issued �_�.-_._ ._--/` ---------------------------_- This Permit Expires 1 Year From Date Issued r Application is hereby,r6ade to the San Joaquin Local Health District for a permit to construct and install the work herein des ibed. � This a plicatio is made in p ncelwith unty Ordinance No. 549. � [t --- JOBADORES AND LO - - ' --- --------------------------------------------- - ---:-- ----- ---------- -- -------- ----------- - -- ---- ---------- -------------- -------- - - , '`t = . - Phori'e ----------------------- Owner's Name______________ _`_____.. . ----------------------- Address------------------------------------•- f ,�. -a-•---------------------- ' --------- ---------------------------- ----------------- Phone. •-------- � Contractor's Name-------��(V��_'�-------------------- ------------------------ - -- - - z� Installation will serve: Residence ,`Apartment House ❑ Commercial ❑Tcailer-Gourt--❑ Motel ❑ Other ❑ .. Number of living units: _1------ Number of bedrooms ---- Nam er of baths Lot size }CR.F0 &F---_________________ Wafer Supply: Public system ❑ Community system ❑ Private�< Depth to Water Table _1.40 ft Character of soil to a depth of 3 feet- San r Gravel ❑1/ Sandy Loam ❑ Clay Lyam ❑ Clby ❑ Adobe ❑ Hardpan ❑ ILI f, Previous Application Made: (If yes,date-----------,.------ I No,❑ New Construction: Yes ❑ Nom FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available wifliin 200 feet.)- 1,7s:4 Septic Tank: Distance from,nearest well-----------------Distance;from foundation_____________ Materia! r____________.___._____-_-___---------_- Tri>�G� k No. of compartments-- =------- ------ ---Size------- = Liquid depth. - Capacity Dis osal Field: Distancefromi nearest well_____J�"Q..-._Distance fromounda' �tian___�_ _._.__....Distance to nearest lot line----!5- p w � r F-) s lek(& Numb,-"NbFIl ne--_-�#-- ---------------- ---Length of eachkli e--.----�Za--`---,i------Width of�trench_----�.Z-��---�-----1---------- -- j "} t>P Type of filter maferial___�Q_e�---Depth of filter material____..�_ ________.Total length___________________� _____.---------- Seepage -it: Distance to nearest well....IPO.-'- -Distance from foundation____-_ -------Distance to4jne6resf lot line�-�.___-- \'a Number of pits.._ .:�-___..__._.Lining, material_ROC.K.____ Size: ------------------ i Cesspool: Distance from nearest well ------------__-Distance from foundation_._..- _.____ ..Linin material _.......__--_--_---------__________ l --Depfh--------- ----- --------- -----Liquid Capacity---- ------- -- als. Size: D�amafer- - ---------- --- ------ --- � _ - ------ -y.9 Privy: Distance from nearest well___________________________r____.-..-_-_____._Distae from nearest building----.------------------------------------- ❑ Distance to nearest lot line _--------------------! ' --------------------- ' -------- ----- { r T 3 Remodeling and/or repairing (describe)------- -- -------------------------- ---------------------' ---------------------------------------------- ------------•----------------------- " al � . - ------------------------------------ t ----------------------- ----------------- -- I hereby certify that I have pre Fred this application and that the wort willTbe-done in accordance with San Joaquin County ordinances, State lawd e and a ulations of the San Joaquin Local Health District. j (Signed) ---._... ....... --- --- (Owner and/or Contractor) - --- - Plot plan, showing size of lot, location' of system in relafion fo-wells, buildings, etc., can be laced bn reversF { p g t y e side). FOR:,DEP-ARTMENTUSE ONLY APPLICATION ACCEPTED BY----- . ----------------------------- ---------•----------- ------ DATE.------ -- T �1 �^ ----------------- DATE�=------------------ ------------------------------------- BUILDING `PERMIT ISSUED_ - ------ ---' ` = DA7E�,=. 4` . .REVIEWED Y----------------- - ------------...... --- --- ------- - ! -- -- --------- -'� Alterations and/or recommendations•_ -.------- --- --- ---- i -.....-• -------------------------- -- ------------- ------- Iv, --------------- ------------- '� E --------------------------- --------------- --------------------------------------------- ------------- -- - - ------------------------------ .. :'. --------------- --- - -------'------ - i � � � Date------ �� z -------------- FINAL'�i`NSPEC7 N BY:_._ SAN JOAQUIN LOCAL HEALTH DISTRICT j .1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street l Stockton,California Lodi, California Manteca,California Tracy,California M E.M.SP 1.67 Vanguord Press