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FOR OFFICE USE: <br /> ----------------------- ------------ ---- ------------- <br /> ..... ..... ............. APPLICATION FOR SANITAy TION PERMIT ' Permit No. ..�p. <br /> ----- --- -- -- -- --- ----------- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County OrdinancA No. 54 . <br /> JOB ADDRESS AND OCATION------- <br /> --- ------- <br /> / - <br /> Owner's Name. - Phoney <br /> �/ ' f <br /> Address-----•----------- a _.r © 7 J - --------- <br /> --- ' - <br /> Contractor's Name --- ----- it.�r�� /?//v ��/� <br /> Phone---- <br /> -------------- -------------- <br /> Installation will serve: Residence a Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �� <br /> Number of living units: .. Number of bedrooms ':3--- Number of baths Z_ Lot size ... -.��. ��..................... <br /> Water Supply: Public system ❑ Community system ❑ Private f Depth to Water Table 5�P. ft <br /> Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: {1f yes,date-.................. I No ❑ New Construction: Yes ❑ No g- FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: LOIN <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (fit <br /> �epti Tank: Distance from nearest well_______.._.----.Distance from foundation--------------------Material ___...-_.......-..-._.._.-_..-...-....__-.-' <br /> r� No. of compartments- ------ ...............Size-------------------- -----------Liquid depth..------- ------- .......Capacity------------------ <br /> Disposal Field: Distance from nearest weEl_S'C�- .....Distance from foundation-_40.....--..Distance to nearest lot line-/,*- .� <br /> Number of lines.--------- ----------------- Length of each line------/CU_'_p-....___..Width of trench---.-- _ -_ °'-"'`':.-- <br /> ri-.De.Depth of filter material_..... ..8._..---__Total len th.....,l .---_------------------ <br /> Type of filter material___�LQ� p � .- g <br /> Seepage Pit: Distance to nearest well/ .f--------Distance fr m fo ndation.-�fG.- .....Distance to nearest lot line. <br /> Q� Number of pits..._/-------------Lining material -. Size: Diameter-___ 5.j. <br /> -�--- Depth --� ------------------- <br /> Cesspool: Distance from nearest well .-.___- Distance from foundation_________________ __Lining material............-_-._._..---------_.-._.. <br /> ❑ Size: Diameter- - - - ----- --- - ----------------Depth--------------------------------- - ,Liquid Capacity------- -------gals. <br /> I <br /> Privy: Distance from nearest well---------------------------------- ------ Distance from nearest building.....----_-_._--_...__.---_--_-___------. <br /> ❑ Distance to nearest lot line ------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): -� �f--- 4 ---- cr ,(x71�� --------- <br /> ----- <br /> ----------------------------------------------------------------------------------------- ----------------------------------•---------------- ------------------------------ ------- <br /> ------------ -------------------------------------------------------------------------------------------------------------------------------------------------•----- -------------------=----------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. e <br /> Si ned �M <br /> { g )------- .....�,_. . ., -- -- - ---------- ........... <br /> -----.-- (Owner and/or Contractor.) <br /> By: �"`- --------=------------------ - (Title) /'�'�' ... <br /> (Plot plan, showing size of lot, location of sysfe 1n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ' " - - -------------- -- ------------------ -------------- DATE-A- -----� .....W <br /> REVIEWEDBY------------------------------------- ---------_--------------------- -- - ----------- -------------------------------------- DATE I <br /> BUILDING PERMIT ISSUED ------ -------------- ----------------- DATE----- - --- <br /> Alterations and/or recommendafions:----------—-------------------------------------/--------- -------------------------------------------------- ------•----- <br /> -------•---- ----------------------------------------------- ------ ---------- <br /> --- -------------- -------- ------------------------------- - ------- <br /> ---------------------------------- _.._- ------- • ------- --- ----- - ................. ---------------------------------`------­-------------------------------- --------. ---- --­------------------------ <br /> ---- <br /> ,, II <br /> FINAL INSPECTION BY: u.-, !� Date--Z'-f�..7b <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.(Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street i <br /> Stockton,California Lodi, California t Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> , <br />