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FOR OFFICE USE: - = ---- _-.- APPLICATION FOR SANITATION PERMIT Permit No. _;2 3 �� - ----------- -: - (Complete-in Duplicate) i - ----------- �� '' ' ""-"-` This Permit Expires 1 Year From Date Issued - --�-- Date Issued Application is hereby made to the San Joaquin Local HealthDistrict for a permit to construct and install the work herein described. This application is made in comp(ian`ce with County Ordinance No. 549. JOB ADDRESS AND.�2L0CATION__ '51/-/7r::......4*' Owner's Name ----- Name------------ - n_---�i�s� ,.� -� - Address-------- `,� �w =�� Pone S`A ---------- - Contractors Name--,:6--__=:Z�( Phone �� Installation will serve: Residence Apartment House ❑ Commercials El ler Court ❑ Motel Number of livin-g units: .._.. Number of bedrooms ------'Nu'mber ofbaths.__ _- - Other ❑ r ..�- - -� _ Lot sizeC} fCr.t-_ --- ---_ -- Water Supply:, Public system E] Community system r b E] Private �' Depth to Water Table_5 ft r .Charactesoil to a depth of a feet, Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam 4 Cla -❑ Adobe ❑ Hardpan Previous-Application Made:•_(f#yes,.date_____ l- No New Construction: Yeso ❑y - FHA/VA:Yes-❑ --No TYPE OF INSTALLATION AND SPECIFICATIONS: + ' (No septic tank oricesspool-permit#ed-if:public-sewer-is-available within_200'feet 1 e - Sepf* T nk: f Distance from nearest well__ "Q__----Distanc' from foundafion_-i—/ __/. Material _�� ✓ No. of compartments: _!:� _- '`Size = !� "rj _Ip:.X- Liquid depth--- - - --7... . Capacity__jt�Z p Distance from nearest well.0 S_----f_Distance from foundation__ /�J- _.._.Distance to nearest lot line__la__�__. rs os Field: Number of lines _____�• � � - :-�.--- ::_--Length of each line.-_- 1___-�/- ......Width of trench.-- --r------------------------ Type of filter material_f_�' ,-_._-. ,y � _ � Depth of filter material- �� -----------Tota! length---.---S-�--------------------------- . Seepage Pit: Distancerto dearest we1LM/d�'� ____Distance �7 fou�datian -._-----------Distance to nearest lot line_. __ -------- "Number of.:prts_._ ` _ __ Lining materia!_/ ._. _4 Size: Diameter.__� . -•----_Depth ._/o`�-�---------- ----- Cesspool: "Distance from nearest well ------- _------Distance from foundation..._..____.___.. ..Lining material __.__ ❑ Size: Diameter --- -------- - -- Depth ---- ---- - -- ------------- --Liquid'Capacit ---------- Privy: - -- -- t - .. � ; -- - y..-------- - --------.gals. Privy; Distance from nearest well_-_ -.._. .._ Distance from nearest•buijdin -- -------- ---- g Distance to.-nearest lot line'_____________________________ Remodeling and/or repairing (describe'----- --------- � }'f__.- _-Z. ------ ------- --------------------------- '-----------•------------------------ - - f - ordinances, StateJaws, a d rules - accordance- ifh-Sa y I hereby certify that I have`,prepared this application and}fha the_work will be done in with.San Joaquin County Wand regul ions of the San JoagLiin;Locai Health District. =--- --- ---------- (Owner and/or-Cantracto-i By-------------------- - - - - - � �- -----{Title}. � -... - "-- (Plot plan, showing size of lot, locationtosystem in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDex �' " REVIEWED BY DATE_..` - --•----------- _ --------- ------------: ------------- ----------•------------ -------- ------- = -;----- DATE BUILDING PERMIT ISSUED----- ------ ------r--'- --� - - ------------------ -,_. -- DATE---------------- Alterations and/or recommen dations:.__I___...:__'"`"'^, - — E �-�°` ;;, ------- ------- ---------- -•---------------------------------- ---- ' -------------- --------------------- ---------------- — ---------------------- - ---------------------------------------------- ------------------------ ---- ----------- - t - ------ ------------ - - .......... ------- i fNAL INSPECTf ----- -- ---- ZDate �. r- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi. California Manteca,California E.H.9 2M 1-67 Vanguard Press Tracy,California - r