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FOR OFFICE USE: -------------------------- ------------------ // --------------- .......... _ ___- _..._... ---------- APPLICATION POR' SANITATION PERMIT Permit No. .f ------------- -------------------- --------- --------- (Complefe•in Duplicate) g �� ----------------- I 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 LO ATION_.___7,:5_�v_?__-- ----- 7--A- --- ------� G " Owner's Name------------- 0-----IVPhone _ �Z: Address----------------------------•--------........---` _'�---------------t------------------------• -----=-----•-----------------------------•-- - ----------------•---------._....--------.. Contractor's Name R 1 -U- - ------ Phone4/4-(6 Installation will serve: Residence Ja Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms _...Number of baths_I----- Lot size _150I--x- -_-______________________ Water Supply: Public system Community system E] Private F1Depth to Water Table 7T—ft Character of soil to a depth of 34feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: (If y'es,date------------------- ) No JX New Construction: Yes ❑ No R' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 Z1�10 _ Septic Tank: Distance from nearest w II_/j�Q .__Distancjtfrom foundation- ~_ .Materfaf _. - No.�of compartments -� -..._____.._.._Size-__ _ �__r•_d�Liquid depth-. .�------ --------Capacity_600-A94Z Disposal Field: Distance from nearest well....-------- _--Distance from foundation....................Distance to nearest lot line_._.___.____..__- [X9k6*l11/[ Number of lines.--._-----------------------------Length of each line-- --------------.............Width of trench----------------------------------- 1n Type of filter,material--------------"---------Depth of filfer material------------------- ---Total length------------------------------------------ N Seepage Pit: Distance to nearest well--------.. _-----Distance from foundation--------- ---.----- Distance to nearest lot line__.._.______--__ ^� Number of its.-- .-----__. .... Lining material.........::...._--.__ Size: Diameter------.----------------Dept ---------- Cesspool: . . Distance from nearest well ................Dista rice from foundation._........-_._.-. _Lining material_..__.---_-_---._._.________________- ❑ Size: Diameter. ------ ------------- Depth =r ----- ---------*......... --- ----------Liquid Capacity-------------------- gals. Privy: . Distance from nearest well__________________________ --------------------Distance from nearest building---------------------------------- ❑ Distance to,nearest lot line -------------------------- ------ --------------~------------------ Remodeling and/or repairing (describe} --------------------------•-•-------------------------- ------ ---------------------------------------- ----------------------- ----------------------------(---------------------- -------------------------------------- ------------------------------------------,--.-----------------------q----------------------------------------------------------------------------- - -------------------- -------- I hereby certify that eh�ae pared this application and that the work wiR be done in accordance with San Joaquin County ordinances, State laws, and reulations of f San Juin Local alth District. 9(Signed(--------------- -------- ---- - -- E; ------------ -o - ---------- -------- -J (Owner �nd r Contractor) I 1 BY: dr - ---------(Title) - - ------ (Plot plan, showing size of lot, location of system in 'relation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -- --- -�. .__._'._.� -------------------------- REVIEWED - - - ------ ------------- ------- - ----------- - - - ---------------- REVIEWEDBY-- =--------- ------------------------------------------------ -------- --------------------------- y------ --• -• DATE-- --------------------------------------------------------- BUILDING PERMIT: ISSUED-------- ------------------------ ----------------------------------------------------- 1 ------- DATE------------------- Alterations and/or.recommendations-.. ------ --------- -------- ---- ---------- ------ - .........................------------------------ -- - ---------------------------- --------------••------------ --------------------------------- -- ---- ---------------- --------- FINAL INSPECTION BY:------", "_ y Date--- -`-3_�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Moaellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, California E.N.9 2M 1-67 Vanguard press