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1"-C uJt: ------- ---------- ----------------- ---- ---- -- ------- - APPLICATION FOR SANITATION PERMIT Permit No. . -- (Complefe•in Duplicate) This Permit Ex fres 1 Year.From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein This application is made in compliance with County Ordinance No. 549. t,4-1 �� ,., described. JOB ADDRESS LOC T[ON- 0_1 �f Owner's Name--- _._.:__(f �-- ' E. �41 t •_. �--�-- _ Address--------- ------• -�.------ --- - Phone_ . ._ Contractor's Name---------------- • __ --•-- / � ----------------------------------- Installation will serve: Residence - -V-- - ----- -- -- -- - �-- -- -- ---� -------------- ----------------- Phon Ole lel t,f-. . - A artmenfi House ❑ Commercial Number of living units: - ❑ Trailer Court ❑ Motel ❑ Other ❑ I � ---- Number of bedrooms . Water Supply: Public system - Number of baths_ :_ Lot size __ _- * ,r _ Y ❑ Community system Y Y ❑ Private Depth to Water Tablet f} Character of soil to a depth of 3 feet- Sand t r-- ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Previous Application Made: (If yes,date__-. m Clay ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No New Construction: Yes 0 No�de FNA/VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------ ! � 15 Distance from foundation-------------- p o. of compartments--- -- --- -- ---••--� -- .-:.-.Material -.------ ---- --- .......................... Size---------- -------- ----------Liquid depth Disposal Field: Distance from nearest well- �e --_-_(}istance from foundation__ - - -- --- Capacity_____________ Number of lines--- �' --.---.-.Distance to nearest lot line___ ----------- -*--.--Length of each line._ t3 Type of filter material- g I • ,.. �� Width of trench-.- �� �'� Depth of filter material---- _ .. Seepage Pit: Distance to nearest well_._-__._.-._ - Total length-- from ength__ / Distance from foundation--------------------Distance to nearest lot line----------------- Cesspool: ------------- �a+-�� Number of pits--- ---------------Lining material------------- Diameter _ Cess ool: Size: -- ------------ -------Depth------ --------------- - ize:Distance from nearest well ----------------Distance from foundation._.__--- ❑, Size Diameter_ -- - .-.-Depth ------ - .._.- material....... ' ignln mat I _ 9 -------..._Liquid Capacity__ Priv _—�--- _. -----_-- - -� -�-- Y� Distance from nearest well "'"� - .---.__:Distance from nearest building ❑ Distance to nearest lot line--_------ ............. g___________------------------ Remodeling ____ __Remodeling and/or repairing (describe):__. --- :- ---•-------- ------------------------------- ------------------------- D. ------ ------ - '. I _W�----- ----- --- -•--------------------=- ------------------------------------ ------------ -- --------------—------------------------------------------------------------------------------_------- ----------------------------------------------- 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..-clad rules and regulations of the San Joaquin Local Health District, (Signed)__- --- - -I _ ------ 1_ . �Y�--------•--•---• -•- •- - �- _ _ f-- -- n and/or Con -- ---. (Owner / tractor) (Plot plan, showing size of lot, location of system in relatio tobuildings, [ ) - -10------ --- - -- -- ------ - ------ - itis------- Ronk etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - --- --- ----------------------------------------------- DATE-------�_ r/-1.7 BUILDING PERMIT ISSUE --- - --- --------------------- ------------------------------------- -- - DATE- --- --------------------- r. -------- Alterations and/or recommendations----------- -- ----- ------------------------------------------------------------- DATE-------------------------------------------------------------------------- ------------------------------- ------------------------------------------ - ------------- ------------------ - .- - -------------- - - - ---- ---- ----- - --•----------fes �J------------ ----------- ._. - - FINAL INSPECTION / - Date--- �-- -- -- --- --� -- -- - • -- - ----------- SA OAQUlN LOCAL HEALTH DISTRICT 1601 F.Masellon Ave. 300 West Oak Street Stockton,California Lode. California 724 Sycamore Street � 205 West 9th Street E,H,9 2M 1-67 Vanguard Press Manteca,California Tracy,California