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�, . ------ cam___ 3 �-- . APPLICATION FOR SANITATION PERMIT Permit No. r^ ---- --- ------ _ (Complete-in Duplicate) This Permit Ex fres 1 Year From Date ssued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th to Issued This application is made in compliance with County Ordinance No. 549. � �/f/ a work herein described. JOB ADDRESS AND LOCATION---./ -------------- Owner's Name --- �°-'f--l_�,.5 ------(7 Lli G-- ------------- Address ` Phone----- Contractor's Name_____..__ Installation will server Residence- = ----------------------- - Phone--------�`•------------------ Number -----•--• ---- ❑ Apartment House [] Commercial - - " Number of living units:'-- ___- Number of bedrooms --- ---- ❑ Trailer Court ❑ Mofiel ❑ Other JA_ Water Supply: Publics stem Number of baths.--,-- Lot size __ 'Y ❑ Communit s stem �� X""�`�Q-- ------- Y Y. ❑ Private 21 Depth to Water Table �/' ft Character of sail to a depth of 3 feet• $and' x'.��❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClaPrevious Application Made: (If yes,date_~ ) No Y ® '°`dobe ® Hardpan ❑ TYPE OF INSTALLATION AND SPECIF1CAT.IONS ® New Construction: Yes 01 No ❑ FHA/VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: A Distance from nearest well_./Cd,fp-_-""Distance from foundation-- --No. Material.�pr.j1_Gr� --No. of compartments_.__. �---r-------Siz ``Liquid depth_.- `{ Disposal Field: Distance-from nearest well..�e _' Distance from foundation--- Number Capacity Number of lines � Length of each line_- ----- of trench_ 2 f r - --Depth of filter material./�_" Seepage Pit:' � -.�-�- --�� _ -- --------- Distance Distance to nearest well._./��-'........Distance from fougdation__-/ '---_--Distancenttohnearest lot line------ _ca-` , = -------- Number of its.` tiS'----- p Lining material_,�-0c.�--.1�--- Size: Diameter------- ---- Dept h--------- O- Cesspool: Distance from nearest well --------------- Distance from foundation._..._- ..... . Lining material-- • � Depth-'---- -- -- ........... --------------------------- Privy: o�- ---------------- ze: Diameter- , --------------- --- -Liquid Capacity--------_--- ----_gals. Distance from nearest well ----- �. y ------- ❑ Distance to nearest lot line -------- ------Distance from'nearest`.building..................... Remodeling'and/or repairing (desctibe):.. --- --------- -------------------- ------------------------------------- ------------------------------------- = •r- ---- t: -----•---•---------------- »� ----- - ----_ - -,., - . . ---_-------------_------------------_____________________________ ___.. ____ __-__ .._ --------------- __________-____________-________-__________________.___________.._.___...-___.__._______-__.____ ' �- hereby-certify that�I_ha.ve.,p'repared this application.and.+hat the work will..be done in.accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District, ri , (Signed)----_ - _ ------------------• ------ ------- -----(Owner nd/or Contractor) -------- -.- ---------- --------------=------- {Title} Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc,, can be place on reverse st" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED eY _ - _ REVIEWED BY.... -- ---- ----------------------------------------------- DATE rw BUILDING PERMIT ISSUED-------- -- ---- ----- DATE--------------- ------------ --- -- ----------------------- Alterations and/or recommendations:___-___ DATE-__ --. - --------------------- -------------------------------- ---- FINAL INSPECTION BY:. ---------- = Date---- -- -`- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. - t 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West 9th Street Manteca E.N.92M 1-67 Vanguard Press rt— ,California Tracy,California f