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-- VQL; ._ ------------------------ ------------- APPLICATION FAR SANITATION PERMIT ----- ---- - -- ---- ---- ---- ------- Permit No. -- - (Complete in Duplicate) ------------------ ------------ This Permit Ex fres 1 Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for s permit to construct and install the wo rk herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.--__ _� �, ------ . - - Owner's Name - .�1 1 ---- ------------------------------- -------- ----------- Address--------------•- S ---------•--•-------------- Rhone------- ---- -----•----- ----------------- ----------- Contractor's Name_.-..- -- _�___-___--• �o ------------- Installation will serve; Residence ---------- e ❑ Mote hone__. ❑ Apartment House --••--- ----- ❑ Commercial Trailer Court Number of living units: -----__ Number of bedrooms ------- ❑ Other ❑ Water Supply. Number of baths _-__-_-_ Lot size __-./_5� X f ,�d pp y: Publics stem Y ❑ Community system f�t -----------------'------------•- ; pth o Wafer Character of soil to a depth of 3 feet: Sand ❑ y Gravel E] Sandy tCla Loamable � --- - ft. Previous Application Made: (If yes,date____________________) No Y ❑ Clay ❑ Adobe ❑ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ N0 ❑ i (No septic tank or eroa cesspool p permitted if public sewer is available within 200 feet.) '. Septic Tank: Distance from nearest well-----------------Distance from foundation _ t ❑ No, of compartments------- -------------- --Size-----• -------Material--------- -------------------------- --- Liquid depth--------- -- .............Capacity----------------------- Disposal Field: Distance from nearest well ---------------------- Distance from foundation____________________Distance to nearest lot line__________ Number of lines-__._-.__- __ � ---- ----_---Length of each line--------- Q- �/ r dei eo, y,nType of filter material-__-_ • Width of trench------ ` _•---_.- ' -- ----------'� Depth of filter material_--- -- - _------Total length-------�So r- Seepage Pit: Distance to nearest welt------------- ------------------- ---_----Distance from foundation--------------------Distance to nearest lot line___-_.____._-_.__ 'S ❑ Number of pits_______ _____ Lining material__- -----------------.Size: Diameter------ - Depth................................. Cesspool: Distance from nearest well_________________Distance from foundation--------------- ❑ Size: Diameter----------------------- --------------Depth------------- ---.Lining material- --Liquid Capacity-- -------------------------------- -- Privy: Distance from nearest well ---------------------- gals. ---------------------Distance from nearest building----------------- --------------=------- Remo eiing and/or repairing (describe):___-__.' ! '1� /L %F' LC'�>------- .� ------------------------------------------------------------------------------------------------------------------------------- / ------ ---------------------------------•------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- -------------- - I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules an regulations of the San Joaquin Local Health District. --------------- ------- -- ------------ --------------- Owner and/or Contractor '(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ------ rA FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - /n -.----- --fix------------------ ------ DATE-- l�' 6 VIEWED BY--------------- --� ------ --------- Is ------- -- ---------- ----------------- ---------------- �LDING PERMIT ISSUED. �- - ------------------------- DATE ------- ---------------- DATE----------------------------and/or rscommendatians:_______ ------ -- - - - -------------------- ------------------- ----------- --------------------------------------------------- INSPECTION BY — - ' ` � - Date -- -.y � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tla:eltan Ave. 300 West Oak Street 124# Sycamore Street 205 West 9th street%Stockton,California Lodi,California Manteca,California Tracy, California " F.P.0 O. /