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FOR OFFICE USE: 11A?\--------- -------------------- 1------- .-_ ....._ ----.-------- APPLICATION FOR- SANITATION PERMIT Permit No. ��'.... ------------ ------ ----------- - --------------- --- (Complete-in-Duplicate) i ---- -- ----------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. ' This application is made in compliance with County Ordinance No. 549qeq� /en , JOB ADDRESS AND LOCATION ��, - --------- -- " v�-! a,�,� ------------------------------- Owner i's Name----)IW-s_..... . _• -"--- ------------------------------- --- Phone 164=--� 77 Address.. --------- r•-' _ L ----------- Phone.��_--------------------------------- ? � Contractor's Name -------- '-tTL.. v I i Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: ../_- Number of bedrooms .Number of baths.I-.- Lot size ' Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table ------ - ff i" Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobee Hardpan ❑ Previous Application Made: (If yes,date_.__......... ..... ) No ❑ New Construction: Yes ❑ No� FHA/VA: Yes ❑ No ❑ 1, TYPE OF INSTALLATION AND SPECIFICATIONS: (No,septic:tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well n �. -Dist ce fro1'fouf�dation._. Material..-_-- --- _ "_- --. No. of compartments_ -....__-_......__Size. _ - L1. �iquid,depth_ Capacity._' . r ' Disposal Field: `Distance from nearest well�10-__-Distance from foundetion..t r+� - r .h1..-.....-Distance to nearest lot lie /-0- Number of lines....___.!.. . .......... .......Length of each line..._ . i i�'rr 1 f 1 , ---Q-------��---..Width of ------ See ---- 1 t Type of:filter material -Depth of filter materiaf----..f.yG.� Total length---------------------- -Q------_--- I Seeps a Pit: Distance to nearest well../�.� -._-Distanc from :foundation.?.f. I �..-.^ ..Distance to nearest lot lin .-..../p i p Number of pifs... .1..._._...._.__Lining material-_..._p._: Size iameter"` � p ' ,�� De tn_..- Cess ooL Distance from nearest well ----------------Distance from foundation.-....__..._.._Lining material.....__.-__----"_" \� ❑ Size: Diameter- -- ----"--------- --- -- ---------Depth--------------- - -------- Liquid Capacity-.------------ -------------gals. Privy: Distance from nearest well_______________ .-.------_.----------_Distance from•nearesf;building --------------- } Distance to nearest lot line _._.... t ---" =:-"" f -------------- Remodeling and/or repairing {describe}:.._...- -. - ------------ -"--"-------=-------------- rF ------------------------------------------------------------ ----------------- ------------- -------- ---- ----- - -------------------------------------- --- - ------------------"------------------- -------------- -- ------ I hereby certify that I have preps ed this application and that the work will be done in accordance with San Joaquin Cxounty ordinances, State laws, and rules and'i•egulations of the San Joaquin Local Healfh District. { 01 (Signed] IS�t[ ?dteeL ._�J� .i��. il...�.. �f1 .� B ' L" ---------------- --- -Contractor) Y - ---------------------------------- - or. - ------ --- - (Title)----- --...----- -- - --- - ---- - " - (Plot plan, showing size of lot, location of system in relation to wells, buil gs, etc., an be placed on reverse side). -1, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. __.__r-..._'-.._._.._._...__.- ' "` /-�Q--(, ------- DATEL. ---- - REVIEWED BY ------------- r'"DATE BUILDINGPERMIT ISSUED-------- -- ---------------------------------------------------------------------------------------- DATE- ; ------------------------------------- Alterations and/or recommendations:....-----------_. - - ------------ ---- ----------------------------- -------------------------------- --- ---- I ---•-•---------------------------- ----"----•----- ---------------- .............. - - ------------------------------- ------- --------------- ---------- - - ---- -------- --- -------- FINAL INSPECTION BY:...7__-_e-. (_-C3_.G- 7-'�_/'O� 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 E.N.9 2M 1'-67 Vanguard Press