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FOR OFFICE USE: -------------------------- .....---"._........__----.- ------------. APPLICATION FOR SANITATION PERMIT Permit No. - ------ ------------- - -------- '�' [Complete•in Duplicate) ' """'", .. '^ Date-issued ... { --------------------------------------------__.-____ti`. --This Perml# Ex fres 1 Ysar From Date Issued Application is hereby made4o-t_he Son Joaquin 16. :al Health'District for a permit to construct and install the work herein described. —This-application-is-made'in,compliance wiWCouhty'Ordinance Np; 549,.' t 1�-/a t � -02_o /'7 Y 7'Tr /`1"' , JOB ADDRESS AND LOCATIONS,.�� -�---- _ ----- _ _-- fC/Cy /V �_____�-� ----- � Owner's Name------ ----------- "--•--• �.-, - ---•---- ----- --- ---------- Contractor's Phone------' ------ ---• --- � -J' -�- 1 - ...,. .:_ .------- `,ref---------------------- -- -------_------------------ 4.1 Contractor's Name - 1 _�,Q.� - 1------- �-n.7- -----"-------------------------------- Phone-447"A��7-- -' Installation will serve: Residence K Apartment House 0 Commercial Trailer Court ❑ Motel ❑ Other ❑ �1 Number of living _ units: �.--__ Number of bedrooms _f/ Number of baths I_____ Lot size -- -�L Water Supply: Public system ❑ Community system [] private)6 Depth to Water Table _75-Tt Character of soil to a depth of 3 feet- Sand ❑ GravelO Sandy Loam ❑ Clay Loam 0, Clay❑—Adobe ❑ Hardpan ❑ Previous Application M�de: (if yes,date._______ __- J No New Construction;`Yes ❑--NO, FHA/VA: Yes ❑ No k TYPE OF INSTALLATION AND ,_SPECIF]CATIONS: ..�..�, . ., ... + �\ (No septic tank o r cesspooh permuted if'plfblic sewer is available within 200 feet.) Septic Tank: Distance from nearest well:" --------Distance from foundation..".B .Material _. o. ---------- No. of compartments_.. ... iie ' ;•Jr?C_ ----------_Liquid dep/h._..S' 2.`r-_ _ Capacity...W'0-v----_-- Disposal Field: Distance from nearest well QO Distance from foundation-_15----.-.Distance to nearest lot line- --------------- f___ ". _ -._Len f`n,of each line-- _ ._ -- Width of french Z If T e ,of'fjlfrematerial ,_ t YP - _. " -- De� � �hoof filter material--- --- -_Tota! length------- ----------------------- Seepage ---- -------------- - .r•: . a-� f Seepage Pit: Distance to�nearestwelLJC -.______Distance om f ndation______ ___ Distance to nearest lot line__________ ___ __ Number of pitsC3�( f�J.�_._.Lining material_ __ _ if ------- Size: Diameter---- ------Depth__a�---= ------ L . i ^ �1� � Cesspool: Distance from nearest well _._ :..,. Distance from~foundation Linrng maters __ ----- -------------------------- ----- ______________ ___ ____ t _, Liquid CapacrfY- ----- gals. ❑ Size,: .Diameter. -- - ---Deptth - , P-. .._ '; --- __ - "\t; ~ Y- Distance to>mearesfest lin �4.` ---------Distance from nearest buildin C � -"LPrivDistance from nearest well__..,,.,` +__ _____ - - '' ------------------ ----------)--- Remodeling and/or-repairrngf(describe:___-_ -LSr-_.____ ------------------------------------------------------1_1-------- 5 I hereby certify that I hav ared this a lication and that the wo k will be done in accordance...with San Joaquin County ordinances, State laws, and rut s an regulations of a San Joaquin Loc Healfh District. I (Signed) -- ------- - F "gwnerand/or Contractor B -------------------------- - ------ --------------- --- -•� (Plot plan, showing size of lot, location of system to relati n to wells, buildi gs, etc., can be placeibnrevers side). . % FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-.. --------------------------------------- --- ---- DATE------ ---`��2-2v--�'�� - ----------------------- REVIEWEDBY------------------------- ------------------ _------------------------- - ---- - -- ---------------------------------- DATE---------- - BUILDING PERMIT ISSUED-------- -- -------------------------------------- DATE--------------------------- Alterations and/or recommendations;...w-'-------- - ---- --- ------r --- -----------"----------------------------------------- = -------:-------•------------ -------------- ------ -------------------------------------------------- -- ----- ------------- ---_____ ----- -- '-- --"'- -------------------------- ----------------'------------------------._..._.__....- � _________________ __ __________________ _._ -_ 3 R ...........................---------._..__.- _..� ,�. _--.._...-._...---.-...._.__.._--....._-.---.-...---•-----__-_.__.•_•__•._.-_-_-.._._._._____..-......_-.-_...--..___""-..---------........... FINAL-INSPECTION'aBY:.. ----- Date............. y- .. ' SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi. California Manteca,California Tracyr California E.H.9 2M 1-67 vanguard Press