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t-UK UFHCE USE: ------ ------- -- -------------- ---------------------------- ------------- ------- ----......................................... ..... . .... A,. _ICATION FOR SANITATION PERI Permit No. ---------------------------------------..-_..........- (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. JOB ADDRESS AND LOCATION.I). ilthxs�--& T �[-'"t` f1� _ -------- - ------------------------------- ff Owner's Name ---9(�` ---- �---------------------- - Phone-•---------------------------------- Address-_- ..(.L ra-------- -------- - ------- ... --------------- ---•-- ------------------------------ Contractor's Name------ - ----- --- _ _ --- ------ --�- ---- ------ Phone----.- ----------------__------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court P511, Motel ❑ Other ❑ Number of living units: __17_ Number of bedrooms _1 77_ Number of baths 1'7_ Lot size ____ --- -------- -------- ________________________________ r� Water Supply: Public system ❑ Community system ❑ Private [!rDepth to Water Tab#e ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ N ` Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well--/�'a-�--_Dista�1�c�e Jfrom foundation---1p-...........Material ._. �__.. p - ('Je !_ `rLQx�St` uid de th '� /5c No, of compartments _X Size q p, -.__.__ Capacity.,�r -.-_.._. 6 4V Disposa Field: Distance from nearest well...-1.�l0_`._Distance from foundation-___Io_�. __.._.Distance to nearest lot lines-t... o Number of lines--------/O--------------------Length of each line;.—� • .Width of trench-.4..--___.__.._...._ Type of filter material _______-Depth of filter length---- 4 '7------------------------ Seep e Pit: Distance to nearest well___f.r�ts-¢ Distance from foundation-----LD__o__--_ Distance to nearest lot line_S--________ , Number of pits .....�-------...Lining material.. -....... Size. Diameter---W-A----.---- Depfh__-2-4`____.______.__--. Cesspool: Distance from nearest well ________________Distance from foundation___ ---- -------- _ Lining material-__._---_-_.--_.____.__._________--- ❑ Size: Diameter- -- -------------- --___-------Depth-- ---------- - ----------------------------.--Liquid Capacity- --------------------------gals. Privy: Distance from nearest well ................_--____.__..._--- ---..........Distance from nearest building....__-_-.__________._____...---__-_-- ❑ Distance to nearest lot line - - ---- - - - -------- --- ---------------- ----------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------- r- ---------- -------------- -----------------------------•-------- ----------------------••--------------------------------------------------------------------------------------r---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a s, and rules and regulations of the San Joaquin Local Health District. n (Signed)----- - ------------ ---------- rand/or Contractor) B - sr ----- ---- ------- - -- Ti ------- ------------------ -------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�,�-- -------------------- --- -------------- DATE.- REVIEWED ATE.REVIEWED BY---- ------ ------------------------------------------------------------------------- -------------------------------------- DATE---------------- ------------- BUILDINGPERMIT ISSUED-------- -- ------- -------------- ---•-------------------------------- __------------- ----------- DATE--------------------------------- Alterations and/or recommendations_________________ FINAL INSPECTION -- --- Date..-1. ------------^�---6� --._..;> SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street i Stockton,California Lodi California Manteca,California r` Tracy,California E.H.9 2M 1.67 Vanguard Press