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FOR OFFICE USE:. - ----------------- -- ------------------- --- --------- �. -- -- ----------_ ... APPLICATION FOR SANITATION PERMIT Permit No. .��.- .:. N (Complete in Duplicate] _ _..... 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. G ,, p JOB ADD RES AND LOCATION..(5EA6 f tj- f---IV- ---�11 � ./�1/ - ----.I "--/�,C ---- 1 � / - p-�i7vt�- Nt1efSts- �//ptil Owner's Name._4_� t,S---------8-0..G-63 -�-A--�-V--0---------- - ---- --- ----------------------------- -------- Phone AJS( --Tff ltA115�" P C1 a..- � - ----- ... Ll- 1� /s/..r.. ° 1 Address �' i Contractor's Name------------- --- ---- ...... Phone 4"(o Installation will serve: ResidenceApartment House E] Commercial ❑ Trailer Court [IMotel ❑ Other [_1Number of living units: _1_----'Number of bedrooms". _.. Numher'of�baths _ Lot size _ _ _ _ ------------ Water ..........Water Supply: Public system ❑ Community system ❑ Private X Depth' to Water Table 7$- ft ° Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ 1� Previous Application Made: (If yes,date---------- -------- ) No New Construction: Yes ❑ No�, FHA/VA: Yes ElNoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) _ µ I t Septic Tank: Distance from nearest well-..-.._..'-------Distance from foundation-.--._--___-__-.-.Material ..-...._�------------------------------------ ❑�C►S-inIG No. of compartments_ '_-------Size----- ---------Liquid depth--------- ------ ........Capacity-----------•-------`-- Disposal Field: Distance from near .t well_ ------Distance Distanee from foundation.....-.F- . .---..Distance to nearest lot line..Zt&_7....... Number of lines.- - . .. -.-.... _----Len th of each line.. �� g �t�-- ft------.Width of trench_._.��--------------------- Type of filter material. _-._..Depth of filter materiaL..�_ _.__-....dotal length__._ �'�LJ- --------------'..._.-_. E Seepage Pit: Distance to nearest well .Z49----Distance om f undation.... . - -_---- Distance to neares ..t line_ Fif Number of plts..0)-----------Lining material. --- Size: Diameter__�_�..r'...---Depth. - -Pte------------- Cesspool: Distance from nearest well ----------------Distance from foundation-----------------_Lining material-_________----.-..--------- ElSize:.Diameter. .. - = ---- - ----- -------- ------Depth- ------ -- - -- --.;:Liquid Capacity- --------------- -------gals. t Privy: Distance from nearest well......................... ----------Distance from nearest building--- } . ] Distance to nearest lot line _-_._ t ------------------------------------------------------------------ ------------------------ Remodeling and/or repairing {describes= --- - - ----------- --- -------- ----------- -Q- ---------------•------------ -------- p ._ ,..�rte;., N --- ------ - �• ----------------- --------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------- --------- -------------------------- -- --------------------------------------------------------------------•------------------------------------------- ------ -------------------------------------------------- hereby certify t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and r ulations of the San 6aquin Local Health District. C [Signed) /^ - ----- -------- - ----{Owner and/or Contractor) By= -- � ------------{Title)----- -------------- ---------- [Plot plan, showi g size of lot, location of system in relat on to wells, buildings, etc., can be plat on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y._.._ _ .�_:_F - -- ---------�1'C--------------------------------------------------------- DATE.--31 --- --6_!-K- -------- ----------------- REVIEWED -- --- -------- REVIEWEDBY------------------------- ------- --------__------------- ---- ---------------------------------------------- --------- DATE----------- ------------------------------ ---------------- BUILDING-PERMIT ISSUED-------- ---------- ------------------------------------------------- ----------------- --------- DATE----------------------------------- ------------------------- Alterationsand/or recommendations:.------ -- -------- ------------------- -- ---- ----------- -- ------ -------------------------------------------------------- --------------------------- -----------------•---------- ------- -- -------------------------i ...... - ----------------------------------•-------------------- ----------------------------------- - ------------------------------------------- ----- - ---------------- ----- -- ------- -------------------- -- ---------------------------- ---------------------------- - ---------- ---------- -- - ---------------- -------- ------- --- --------- - - - ------------------- 3 l Ii� � �1 r FINAL INSPECTION BY:..- -- - �--------------------- Date----- .� 1 'r SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Hazelton 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