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FOR OFFICE USE: -•---.• ............. APPLICATION FOR SANITATION PERMIT Permit No. ............... ................ (Complete.in Duiplica+e).(, ....... --------- ............ -------- ......... 'Tris Permit Expires 1 Year From Date Is-su'ed 7 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. IL -OCATION.,///.7 Azdta/ rdw.��_k JOB ADDRESS AN. . .... .... Owner's Name--- ............. Phone......-•••-•--•.......•....I....... Address........... .. ... ... ..... e ................._.............................. Contractor's Name..... _41-4Z--------------_-_ ................. ......._............. Phone----------------------—---------- Installation will serve: Residence eApartment House [] Commerclial [-] Trailer Court [I Motel El Other ❑ Number of living units: Number of bedroom-3... Number of bafhs-.,ey Lot size ......................... 7 Water Supply: Public system ❑ Community system E) Private 25' Depth to Wafer Table ft Character of soil to a depth of 3 feet- Sand [] Gravel [] Sandy Loam`E] Clay Loam 0- Clay El Adobe 9-<Hardpen C1 Previous Application Made: (if yes,date_.._........._....) No 7 New Construction: Yes E] No [I FHA/VA. Yes D No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availab6 within 200 feet.) I ....J.4.........Material... - --..............- Sep;f*;,T;,,,nk: Distance from nearest well__4F9�'Distance from foundation 140*4414Z No. ofcomparfments.....�............. depth__4 Disposal meld: Distance from nearest well.. . Distance from foundation.--/-e.. ...Distance to nearest lot line--f ......... i Numberjof lines..........2.................Length of each line.. ....Width of trench...A_'o-----.- -..-..-.-__---- of filter material.......;5�R, Depth of filter rnaferial_./f..........Total length.../-:5iv...................... S d�. .......Distance to nearest lot line....$......... Seep If: Distance to nearest Disfance from founclaflan,..../ p/OP Number;f pits...-...2..... ...Lining material.....47f&?......Size: Depfh.____P_2--!5r .......... Cesspool: Distance from nearest well................Distance from foundation.-........e_.__.1ining material..............................__--- El Size: Diameter... ._...........................Dept h......---...................... ---Liquid Capacity..............._............gals. Privy: Distance from nearest well.._--.:...,_-...__..........................Distance from-lhbaresf building................_..-.._-......_.._....... F-1 Distance to nearest lot line................................................... ...... ............................... ...................... I ---— -----Remodeling and/or repairing (describe):.. -- / I ---- -------------------- - .. .....................................................-------l_-............I....................... . . ... ....................................._....................................... ................................ ......___..............................._......___..........................................................;��.............................................. ........................... ........ ---••-=---...._...........•--•--/--------.................... ....... -------------------................................ I hereby certify that I have prepared this application and that the work will,6e:Aoiiql in accordance with San Joaquin County ordinances, Salle laws, and rules and regulations of the San Joaquin.Local Health Disfriiif. (Signed)....... .............. L9 BY� ... . ..... ......------ (Sj ---------- . ...................-...................... -------------- _jcmw and/or Con+ractorl ........... ....................................... ............(Title) -------------_................. (Plot plan, showing sire of lot, location of s. em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .......... .................................... DATE..2i_.18'_ ..7....----.._............_.... REVIEWED BY...........................7' ..... ------- DATE__............................................ -- ......... ---------- ----------------- BUILDING PERMIT ISSUED....-....................................... ................... .... DATE...--.:........_....._,__.................. ........... -----------------*..........*-------------------- ................................ X ......... 6....... .... .....-------- ----------------------------------- ----------------------------------------- _.................................................................... .........--------------_-................................................................................... .........._...................................................................—................. ......... ................................................ ........ ............. ..........—1.1.---............1-.............. ........ ...................................................... FINAL INSPECTION BY:.._-' . ..........---------- Date............ .................................. 0S AiQUIN LOCAL HEALTH DISTRICT 1601 E.Maxottan Ave, 300 West Oak Street 124 Sycamore Street 205 Wait 9th Street Stockton,California Lodi.California Manteca,California Tracy,California E.H.42M 1.67 Vonguard Pre"