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FOR OFFICE USE: --------------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - ------------------------------------------------------ (Complete in Duplicate) Date Issued ------------------------------------------------ This Permit Expires 1 Year From Date Issued- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install therk herein ibed. This application is made in compliance with County Ordinance No. 549. O(a 3 230--t �Z3tz /U . f4rrs-4��0 A-J* JOB ADDRESS AND LOCATION ��`�'� -�14,� + `�'-_ +o14,Apwr��r ------------------------------- --------- Owner's Name.------ --ge-P�--��-�1---f- ---- --- -------------------- Phone------------•----------------------- Address-------------------El�1t ---- f --•-•------- Contractor's Name______ __ f 4`�--------- ` - Rhone.. Installation will serve: Residence ®/'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1400... Number of bedrooms A.. Number of baths A._._ Lot"size��--aAol`—------------------------------- Water _ __________________________Water Supply: Public system ❑ Community system ❑ Private gt'" epth to Water Table tiff' 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay❑ Adobe ❑ Hardpan ®^ Previous Application Made: (If yes,date_/-"W-77-00 No ❑ New Construction. Yes ❑' No FHA/VA: Yes Z —No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Seaic Tank,:: r Distance from nearest wel!_________________Distance from foundation--------------------Material------ ----_---------------------- No. _.____________..__-No. of compartments--------------------------Size-------------------------------Liquid depth --- ------- - - ---- - Capacity----- ----�N Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- W )\l ®' umber oflines-----------------------------------Length of each line-----------------------------.Width of trench-------------- --`..� Type of filter material________________________--Depth of filter material-----------------------Total length___.____________________________________. . �_ Distance from foundation_e 49_.r-___.Disfan�e to nearest lot line--? -- See+p�ge Pit Distance to clearest well__ _ ____ �� Number of pits_____..___.._____Lining mate ria L_ f�d' .�-Size: Diameter___ -_______Depth r ----------------------- Cf, ____________________ C s - Distance from nearest well-____--____--._Distance from foundation____________________Lining material------------------------__.-______-_. r. Size: Diameter--'n__„_- --Depth__-.,----------------------- - ----Liquid Capacity ----".gals. I Privy: Distance from nearest well------------------------------------------------Distance from nearest building---------------------------------- I] Distance to nearest lot line...------------- ZyZ_,W_,0;P4, j ---------------- 1 ------------- ---------=-------------------------------- z"'41 Remodeling and/or repairing (describe):__.____.._._ _ G - --------------------------------------------------------- ---------- -lc-- 'a 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 rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- / '(mor Contractor) 0 BY '----------------- ------------ 6 - (Ti#le) 3 (Plot plan. showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATE --- -�----w - ------------------ REVIEWEDBY------------------------- ------- ------ - -- ----------------------------------------------- ------ ------------------ DATE------ ------------------------------------------------ -. BUILDINGPERMIT ISSUED--------------------------------------------------------- -----------------------------------------.-. DATE------------------------------------------- ------------- Alterationsand/or recommendations:--------------------------I——----------------------------------------------------------------------------------------------------------------------- - -------------------------"-------------------------------------- --------------------------- ----------------------------------------- ------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ------------------------------------------- ------------------------------------------------------------- -------------------------- • -- --•------------------------ ------------------------------------------------ ------------------- - ------------------------------------ -----------------------------------------I---------------------------------- ----------------- -------------------- -------- ------------- ---------- - ------------------------------ ---------------- -------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- -a -�- ✓/`.--------- 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 F.P.CC.