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r FOR OFFICE USE: Ce. 3: � --- ------------------ __---.-----_ APPLICATION FnR SANITATION PERMIT Permit No. . _... .__.... --------------•---------------------- ------------------- {Complete in Duplicate} Date Issued __..___1-_..M �7f� `! " --------------------------------------------------------- This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. i This application is made in. compliance with County Ordinance No. 549. `� ��} ; 't7��=� 2Zt�-!/ ee4c. r JOB ADDRESS AND LOCATIO,, _Vi.�R .l7_-.-• -�'--------- Owner's Name--- - -. --------_�-____ .....------- `---------------------------------------------------------------- Phone mow--- . l Address------- . ... . -/----•••------------- Contractor's Name ' ..............•......I-. ------------------- Phone.). ��r7-- t Installation will serve: Residence`[Apartment•House'.❑"FCD"rmtngrcial`❑j rail r Court'❑"Motel ❑`Other`❑ Number of living units: .... Number of bedrooms'j./.. . Ni b �umber of ath _____ Lot size .__._ e __ 1-. _s !_____'----------------- Water Supply: Public-system Community system'01 Private ❑ Depth to Water Table '0. ft. �4 ' 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 ❑ a New Construction: Yes [j�o ❑ FHA/VA: Yes [�Nlo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: cn : 1 (No septic tank or cesspool permitted if & 4ublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well/__�9K ._ clation--- k Domistaffom foun ..............r� 7 'depthNo. of compartments--------- 71tq -----�---------------Capacity- ...........J.......... Disposal Field: Distance from neare., well�dh�_Distance from foundation....1. ......_.Distance #o nearest lot hne_________________ L� Number of lines..... ..........i_-_- Length of each line&=kg97 31 4 idth offtrench-----�_ ------------------ . Type of filter material._y Depth of filter material___-- -----Total length................. .. Q.. Seepage Pit: Distance to nearest well-----------------------Distance from foundation------.------.......Distance to nearest lot line................. ❑ Number of pits---------------I-----Lining material-----------------------Size: Diameter-----------------I......Depth................................. I Cesspool: Distance from nearest well-----------------Distance from,foundation.__.--____-_.--.._.Lining material---------1___________________________ Size: Diameter----------------- I— :De th:---------..-#_._ �'_"`*r- � . Li uicl 'Ca aci ❑ p ---F - _9 p ty gals. I Privy: Distance from nearest well------------------------------------x-----------Distance from nearest buil&6g:!!t......................... ❑ Distance to nearest lot line--------------------------------------------- Ramodeling and/or repairing (describe): ------------------- ------------------------------------------------------------------------ f -/ IA j ..� ----------------- ---- --F=-- -•------------- •---------------------------------- --- ! i I hereb certify that I.have prepared this application and that the work will be_6one in accordance with San Joaquin County ordinances, to laws, acid a and re lattons of a San Joaquin Local Health (Signed) f ' _ I ------------------------------------------- caner and/or Contractor} By: ------- 'A-'•- ....[tel-- - ....(Title)... -- - ---•-- ---- ----------- --_--------------- (Plot plan, showing size of lot, location of system in rela'T"A to wells, buildings, etc!, can be placed on reverse side), t r e. 1 FOR DEPARTMENT USE ONLY f _ 1 APPLICATION ACCEPTED BY----- ----------------------------j- ---- DATE.....i.7---= 12=6---2------------- REVIEWEDBY-----------------------------•------------- --- -- ---------------------------------------------------------f- x---------- DATE i -----------------•------------ BUILDING PERMIT ISSUED - - DATE ---------------� =------ •-------....._ Alterations and/or recommendations_____________________________ f t ------------------------------------......... ._............... ----•-------•--•-•-----•-------•--•-----•---••--------•-------� -------_=-- = ....-. -------------------------------------------•------------•-------- .......................................--------------------------------------------------------------------------------- -------------------------------------------........................................... -------------------•---------------------------------------------------------------------------------------- ---._....... ..........---------------------------------------------------•------------------------- FINAL INSPECTION BY .. ---------------------------------------------- SAN JOAQUIN-LOCAL HEALTH.D,ISTRICT•= -� ., -,j 130 South Ameriean'StreN 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street i � T Stockton,California Vk Aodi,California > Manteca,California Tracy,California E9 9 REVISED 6-89 2M 5-81 ASLAS041'! .. -� K .� • R �;, M { }