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FOZOFFI�t USE: ----- - -------------------------------- --- ----- - APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) ��%,-13 k • Date issued --- '------ ---------- h This Permit Expires i Year From Date Issued 2 S_6 f-40�Q2 Application is hereby made to the San Joaquin Local Health District for-ra permit to construct and install the work herein described. This application is made in compliance with County Ordinance.No 549 JOB ADDRESS AND LOCATION r� � ''� ��` - -------,r`� ---------------"r ------ -1- A- - . Owners Name = '1 j� - - = ----------- . - Address I t ` - 1•fne ------------------------ Contractor's ............... ----------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other [/ o n Number of living units: I.---- Number of bedrooms� 3_-Number of baths I-.- Lot size �---------------- Water Sup ply: Public system ❑ Community system'❑ Private "I Depth to Wafter Table., ft Character of soil to a depth of 3 feet-:Sand ❑„ Gravels] ;--Sandy Loam Clay Loam E] Clay E] Adobe C] Hardpan E] Previous Application Made: {If yes,date-- - } No '� New Construction: Ye SA No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF.IN_STALLATION AND;SPECIFICATIONS:— �• �` w }-- �° — "`'"— ""' "� ' -��` T}(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y _ . Septic Tank: Distance from nearest welL.c,,0f�_ Distancrom foundation-__ _ e1 !f 1'�_� .Material/' ' - - Uq No. of compartments-.____`-9 _•-..........Size,5. --)(&6------Liquid depth__47_V _=___..Capacity__/_1P.(?---- Disposal Field: - Distance from nearest well-�2.00bistance from foundationa_9.rlr_:_t-_.Distance to nearest lot line--k—on. * ► b.1`Number of lines ----I_-_-__-__-- Length of each line__._ 7_0----.jr.-_.-.-.Width of trench! F~ Type-of filter material._-...---1--...:..........Depth of filter material__- _.__ Total length----------------------------- ._ p 5 - �, f x,r See a e Pit: Distance to nearest well:a•s f _"�_._Distance from foundation�_V_��Distanc .to nearest lot Numbe of.:pits. Lining material-------------- t {0 1L--'Depth--�/- Q �I _ Size: Diameter-_ / Cesspool: Distance from nearest well ________________Distance from foundation_.__ :..... ..Lining material-....---------..----.-_.-----_------_ ❑ Size: Diameter- -- -------------- --- ------------Depth------------------' -- x- - -Liquid Capacity----------------------------gals.�r1 Privy- 1 Distance from nearest well--_.___-------------------------_...._..__3Distance from nearest Building.__.___.______.____.____________....__.... ❑ !,1�_ Disfance-to-nearest=lot line ..---_-- -- Remodeling and/or repairing (describe}:_. . ------------------r------------------------------------------------------•---------------------------------------------------------------------------------- ----------------------------------------------------------- �S t` ------------------------- ----- --------- -- -------- -------- -------------:--- ------- -------------------- --------------------------------------------------------------------------------------------------------------------------=_------=------------------------------ I hereby-certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordlnances,.5ta .e laws, and rules and regulations of the San Joaquin Local Health District. - _ :- � (Signed ------' r '* Owner,and or-_Contractor - - _ f. By: '—�_f. ! � -s r}' ---(Title) . (Plot plan, showing size of lot, location of system 'relation fo wells, buildings, etc., can be placed on re erse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------- -------------- --- ------------------ --- ---- ----- DATE------- -� r ! DATE BUILDING PERMIT ISSUED-------- -- - ------------------------------------------------------ -- = ------ DATE-- --------------------------=----- ------------------------- Alterations land/or recommendations:-------------- - -- -------------------------------- -------------------- ------- --' ................. -- — ---------------------------------- -------- ---------- ---------------------------- FINAL INSPE ----- - -- - _ Date---' -----7 ---------------------------------- SAN JOAQUIN LOCAL/HEALTH DISTRICT 1601 E,Hasetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press E