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FOR OFFICE USE: W, -------------------------------- .------..-..----- --------------- „� APPLICATIQNFOR SANITATION PERMIT Permit No. . c ! -3 --------------------------- .......... (Complete-in Duplicate) DQ -.___--------- ___ This_Permit Expires 1 Year From Date Issued Date,issued . -------------- Application --- -Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr ed. This appiictior is�made in c lance w unt Ordin o. 549. JOB ADDRESS AND LOCATION l"--------- --- --�_� - - �rJ` Owner's Name n's . -------- ,>, . Phone--------------- ----------•-------- Address- ---- �3 _ - E ' ....L �_of_.. .r ----;----- � --------- ------------------...__.....-------..... ------ .........................-- Contractor's Name------. -T. `'(PSL,• ^*r,?"' ----- ------- -- ----------_- s Installation will serve: Residence X] Apar#rnerif House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: __ .____ Number of bedrooms _ ___._ Number of baths ... Lot size __.'), A Cr Water Supply: Public system ❑ Community System ❑ Private N Depth to Wi ter Table ------- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayX Adobe ❑ Hardpan ❑\ Previous Application Made: (If yes,date____..____,_...__. ) No K New Construction: Yes ❑ No ❑ FHA%VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool,permittecl it publi sewer is available within-200 feet. Septic Tank: Distance from nearest well_________________Distance from f undation___:._.._._________-Materia_..___.._:.__-___.____--___________...__ No. of compartments......::......r�: ----Size--------------------- --------Liquid depth--_ ' S-- ........Capacity:�IZ-o-------_- Disposal Field: Distance from nearest well_.::.._.... Distance from foundation_________________ Distance to nearest lot line_______.-____-._ Number of lines.---------------- ----------- ---Length of each line.. --------.------------------Width of trench----------------.------------------ -T,ype of filter material_________ .........______Depth of filter material_._.___.___.._...._._Total length____ ----__________f,/.!________________. Seepage Pit: Distance to nearest well...---------:.........Distance from foundation--------------------Disfarice,to nearest lot line____________... ❑ ..Number of pits--- ----------------..Lining material------------....- _t-- Size: Diameter-------------- ------Depth-- ------ Cesspool: Distance from nearest well ._....>__....:__Distan-e�from foundation_..._.____.__... ..Lining material______________________._____________ El i Sizc: Diameter- -- --------- --- ---.De th_- ---------_.__ f - -----------------Liquid-Ca acitgals. Privy: Distance from nearest well-.........:.::.:............___`- Distance from nearest building__.____`------- -------------------------- ❑ Distance to nearest lot line ----------------------------------------------•-------------------•--------------- Remodeling and/or repairing (describe):....... ...... .. ... ....... ------- # i --------------------------------- ----•-------- ----------:-- ------------------------•- _____-_.____•_____•________________________________________-----------------------------___________----------------------------_----------------------------------------------------------------------------------------- --- ..._ L X' I hereby certify that 1 have prepared this.applicafion.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)__1__4____14/-- � - � `= ------------------ --- -- ------ ---------- ----------------------(Owner and/or Contractor) --............. -- ----- =- -----------------Title ---------------------- -----------.......------- -- (Plot plan, showing size of lot, location of system in relation to wells, .buildings!,of;c`an-be_placed on reverse side). 4 F f FOR DEPARTMENT USE ONLY`, r APPLICATION ACCEPTED BY-- .. ....... � 'e - DATE S I REVIEWEDBY ------------------ -- .._.... -------------- ------------------------------------- DATE-------- ------------- BUILDING PERMIT ISSUED-------- -- ='- ----------------------- DATE----------------------------- ---- Alterations-and/or recommendations:---...: ......... — # I ------------------------ ---- - ----------- - ---------- ------------------------------ ---------------------------- ----------- -------•------------------------- „77 4 i � _ �' - - '- -' --------------------------- ------ ---------------------------- --`- FINAL INSPECTION B :___�� --____._... — yr , Dat ------------- - - - - SAN JOAQUIN_L_OCAL HEALTH DISTRICT 1601 E.Haxallon Ave. 300 West Oak Street -124 Sycamore$I rest 20.5 West 9th Street Stockton,California Lodi. California Manteca,Cclifornia Tracy,California E.H.9 2M 1-67 Vanguard Press