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FOR OFFICE USE: --- APPLICATION FOR SANITATION PERMIT Permit No. Of� --•. ------ ------------------------, (Complete in Duplicate) -' _-zo -- Date Issued ___p1�_____� - - ------------------- - ............ 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 the work herein described. This application is made in compliance with County Ordinance o. 549. JOB ADDRESS AND L CATION _�7._ " " *41 p� / � Owner's Name--------- -- ,/�=''�'�---------- -- -- ---•------- --••------------- -- ----------------------------------------- Phone---l-� r----z-V- Address-------------� ------ ----•-- - Contractor's Name-------- -- --------- s ------.�--�-0-4-----J ve ------------------------------- Phone.-,,&"1�-- J--2-®--Y Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f__ Number of bedrooms _,?--- Number of baths _Z__ Lot size _-.- d_____. -_r ................. Water Supply: Public system ❑ Community system ❑ Private P' Depth to Water Table 60-r-lft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: {If yes,date---------------------) No)K New Construction: Yes, ' No ❑ FHA/VA: Yes ❑ No LK TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /y s Septic Tank: Distance from nearest well_______ Qistan f om founda�ion__1 __ ---.__.Ma#eaL_______ __ _______ ( No. of compartments-----.-t�__-._ ,.V41kx-�Liquid depth---__ser------------------Capacity__/c,Z_00 ------- Size- .• -- f ! e�f Disposal Field: Distance from nearest well...�0--_ ._Distance from foundation___ __/�-.._._.._.Distance to nearest lot Ime___ Number of lines___._____._ Length of each line____ Width of trench... _._ .___�� 9 AG" - - -- ----- �5e r Type of filter material--- - .Depth of filter material__� _.____......Total length_-_ --------------------- Seepage ---__--_- Seepage Pit: Distance to nearest well.-le-0. Distance f om f undation-_`�_ ........Distance to nearest lot line--t�__.-----_ rxNumber of pits.... a�,�-------------Lining material-_X -----Size: Diameter-_-7-%?.. ...------Dept h-------p a ___---.---_-..- Cesspool: D'stance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------------------- El Size: Diameter Depth - -- - Liquid Capacity ----gals. Priv Distance from nearest well-------------------------------- .--..-Distance from nearest buildin 0 s Distance to nearest lot line------ ------------------------------- ----- -------------------------------------------------------------------- --------------------------- Remodelingand/or repairing (describe)---------------------------------------- ---------------------------- ---------------------------•-------------------------------------------------------- --------------------------------------------------------------------- •------------- -----------------------------------------•----------------------------------------- ---------------------------------------------------- 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. (Signed) -- -_------ -----------------------------------------Owner and/or Contractor By:---------cc�,- 414k --------------------- ---------------(Title)------ ' '`' -------------_---- -------------- (Plot plan, showing size o{ ot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY C� ---------------- DATE----------15-_ --ffkli! - APPLICATION ACCEPTED BY - ---- ----- - -- ------------------------------------ -------------------- REVIEWED BY--------------------------------------------- ----- --------------- ------------ -------------------------------------------- DATE-------------------------------------- --------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE.------------------------- --------- ----------------------- Iters ons a �or recomme dations:_ ---------- --- - - .�� - --. --- cam - - - - - �'`-- -----------------------------�--------� --------------------- ------ ---------_----------------:..------------,--- -------- V-11ALI BY.. ' -------------------------------------- Date `:a -�--- --- ------------------ s / 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.CO.