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a° FOR OFFICE USE: ------------------- -- -------------------------------- -- i ----------- APPLICATION FOR SANITATION PERMIT • Permit No. ---------------------------------------------- (Compleie•in Duplicate) --- ------------- -- This Permit Ex Cres 1 Year From Date Issued Date Issued -------------------- ---- P' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew k herein s ibed. This application is made incompliance with County Ordinance No. 549. , JOB ADDRESS AND LO_CATION --. -_. o -_--- Ev n e- - ... _ - ------- Owner's Name----- --•--- ---- - - - --.-.- Phone--------------------------------------- Address...... ------------------•---•-------•---Address--..-•-- ../ . . -, - - --------------------------------------------------------•------=------------•-•- Contractor's Name---------- ..f ------- f es.. "-------------- - ------- ------- ---------------- --------------- Phone------ ---------------------------- Installation will serve: Residence ET*_'iapartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.-/--- Number of bedrooms 3---- Number of baths ..- Lot size -----yIXe... -_ ..7 -------------- Watei Supply: Public system ❑ Community system ❑ Private [9- Vepth to Water Table/-11' ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay E❑ Adobe [] Hardpan ❑ Previous Application Made: (If yes,date--------.---------- ) No Pq''New Construction: Yes E?-No ❑ FHA/VA: Yes 94--P No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt-�-..----Distance from found�on:XQ--s_____ Mat ial -. ----------_ No. of compartments-� --.----._-- Siz JVY�~....$,-_f_-__Liquid depth__ --.- _ .Capacity-/,Z-e0-- (N Disposal Field: Distance from nearest well_,Z47..-------Distance from foundation-_/•0___`--...Distance- to nearest lot line--bo--.-------- 41 I 3 ` Number of lines.--_._A------------_----_-----Length.of each line--.fPl�°.--.---_-..Width of trench. X._------------------------- Type ------------------------ (� T e of filter materi p ferial...e�. -..Tota! length--2.� °-------------------- .41 f i ? Seepage Pit: Di�ance to clearest well D scan e friltmrfou ation-LA9-__-----. 's ante to nearest lot ine- .----.. Number of its-- Linin material - .-. Size: Diameter__.--- -Y_-__--De v� _E.--, - p g pth__ 40 , Cesspool:- Distance from nearest well ----------------Distance from foundation-______-----..... ..Lining material-_-__------------_-.----.-„r- ❑ . ----- p ------------------------- qCapacity-------------- __t---------gals. Size: Diameter- -- --------- ----- - ----_De th__--.---------_-- ------_Li Liquid Privy: Distance from nearest well.....---------------------------------- -- --Distance from nearest building-----------------------------------------. , ❑ Distance to nearest lot line----------------- - --------------- ------ ---------------------------- Remodeling and/or repairing (describe):........./1.��; .��G'1'� ` � /�--------------------- •-------- 1 ------ ------------------------------------------------------------ _ - :•------------------------------ --- ------------- 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 rules and regulations of the San Joaquin Local Health District. . f ,gip �+ 1 .t (Signed)--------------------------- ?f�_1 0' ..-.1 �. : - ------------------------------ - ---- .-- - .-.- -(Pwner and/or Contractor) BY: - ------------------------{Title} �1_., .'------------- -------- (Plof"plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed oreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ .. . ------- -------- ------------------------------- DATE-- REVIEWED BY---- ------------- ----- -- --_ ---- ----- DATE ------------------- BUILDING PERMIT ISSUED-------- -- - ------------ -------------- DATE Alterations and/or recommendations---- - ---------- ------ --- ------ ----------- ----------------------------------------------------------------- -- = ----------------- --------------------------------- ---- FINAL INSPECTION BY:- -- -- _ -. .--- ~ ------ -------- --- Date-- - .- ..- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 306 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