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FOR OFFICE USE: 3D -fir 6 1=----------- ii___-.f_ %PPLICATION FOR SANITATION Ft_,..AIT Permit No. . ------------------------------------- -- -- (Complete-in Duplicate) Date Issued ...____.............. ----------- ------- 'This Permit Expires] Year From 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. 55499. I JOB ADDRESS AND LOCATION..............°z $ '^� Owner's Name-----... •--- •. Phone ------------------------------------. . �' t Address.....................------ --------------• • -•-•--. .............. -------------- ................................. Contractor's Name............... .•---- •--••---- -•••---- - ---- --I—,--------- -- -• -- ------------------------------------------- Phone.yGl...e�oe Installation will serve: Residence ❑ Apartment House ❑ Commercial 5?( Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- ----- Number of bedrooms -------- Number of baths pR._- - size ---- .., ...07.7 S..................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table SZ ft Character of soil to a depth of 3 feet- Send ❑ Gra"vel ❑ Sanely Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,date................... ) Nox New Construction: Yesx No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if ublic sewer is available within 200 feet.) Septic Tank: `Distance from nearest well. �... . . E` �!'�__Distance from foundation-./,..1Q.•------.Mater) AP'-------------------�.-- -. \No. of compartments-------C9.......... _ , __Liquid depth------- Capacity.I_....- sposal Field: `Distance from nearest well2104..Distance from foundation...9.®.-. ...Distance to nearest lot line.- ........ Length- of each line.- r `.Number of lines__.__G�_...._... g �•�._._-J'-'-S.__..Width of trench ................. Type of filter material_S'. .d.c _Depth of filter material..-yl ....Total length-------/.,:S._a__-____-- ------------ Seepage Pit: Distance to nearest well.-?z�Cl�-t------Distance om f undation....?.0.......Dista5} a to nearest lot line... Number of pits--.-�---------_Lining material..10 -_ Size: Diameter:..��j..3------------Depth.. oZ.-T.•---------------- Cesspool: -------------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---------------------------------------------------------------------------------------....--------------------------•---- ---------------- 9 ,,f -Pi Remodeling and/or repairing'.(describe) C�-- "-'---- ----- 6 ------ . - ------------ -•----...--.............................................--•----•-•••--•-----------••---•--------------•-•----••--•--•--••--------------•-------------------------------------------------------------------------------- -------------- ------------------------------------------------------------------------------------------------------I--------------------------------------------I----------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulps andLegulations.ofthe San Joaquin Local Health District. Si nedti--- .-_-... _ ssd/�t,Contractor) ( 9 ) ---------- By:----•----...----••--•----•------................................................. --------- -- ........ 10--- -- ....--------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). \ / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- V-0_Lt--- ------------------------------------------------------------ DATE-� .- q G --------------------------------- REVIEWEDBY------------------------- ---------_--- ----------------------------------------------------------------..--------•----... DATE..........................................................-- BUILDING PERMIT ISSUED---------- ------ DATE------------------------------------------------------------- Alteraltions and/or recommendations-— - --------------•-------.------------------------------------------------------ i- h<- No FINAL INSPECTION BY:.---------- co<<. ''� - ------ Date.------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 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