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FOR OFFICE USE; �. -- ---- ------------------ -- - /-.-_2'A_1. APPLICATION FOR SANITATION PERMIT Permit No. _.sz2.a_fd d- 3 t .----. (Complefe-in Duplicate) 7 This Permit Expires 1 Year From Date Issued Date Issued -__�rT--= 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDR�tS XND OC TION----_( '._ _--.,� Owner's Name - ------ ------------ Phone------------------------------------ Address Contractor's Name--•--- Q/ � � / -------- ------- -------------------------- -------- ------ Prone------ ---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-- Number of bedrooms -A.- Number of baths _1--- Lot size ----117 -`xlex_/44410' ----.--.-- Water Supply: Publicsystem e-E-ommunity system ❑ . Private ❑ Depth to Water Table ft Character of sail to a depth of 3 feet- Sand ❑ , Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe ZrIgardpan ❑ Previous Application Made: (If yes,date-......... ....... ) No R�1' New Construction: Yes 0-No ❑ FHA/VA: Yes W5;-:;�No ❑ 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--- '------Distance frgm foundation---,/ ------ Mat7ial ��1"' - e .S - ------- No. of compartments-___q ....---____---Size- '-_ .(8----==9-,✓Liquid depth_-.�,/ ..- .Capacity._�Q _.-__ r �� T 1-, Disposal Field: Distance from nearest well.....- Distance from foundation---IL ---...Distance to nearest lot line.__-..--..- �� Number of lines.__-___ ___--_ Length of each line-- JQ-�------------- of trench_ I Type of filter material-f-Al WQDepth of filter material---_. ��-_Total length--.-.-. __(, _ -.----_------------- i Seepage Pit: Distance to nearest well---------.- Distance fr�oj foun anon..- Q.__ Distance to nearest lot line__�,i`-.---s.-...- / - Number of p,ts--- -- -----.-._.-.Lining material--. _0dZ Size: Diameter_-. ---- -_--DepthAt -------------------- Cesspool: Distance from.nearest well ----------------Distance from foundation----------------- ..Lining material------------------------------------- 1-1 Size: Diameter- -- --------- ----- --------------- Depth-------------- ---------------------- -----..Liquid Capacity- --------------------------gals. Privy: Distance from nearest well_______________..........._------_-------------.-Distance from nearest building.--.__._------.-.---.___-----------__-- ❑ Distance to nearest lot line ------------------_-------------------- ------- - Remodeling and/or repairing (describe) 1 �✓/p �-�.� J��c &_ -------------------------•------------- ---------- ------------- ------------ -- ----------------------------- -------------------------------------------------------------------------------------- ---------------------- --------------------------- - - ---- I hereby certify that I have prepared this application 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. i (Signed)----------------------- ---------- u �� -c------ ---- ------------------------------------ antractor) ) BY ---------------------- --------------------- (/6/ --- ---(Title)----,CO/V/7 i/ '- . --- (Plot plan, showing size of lot, location of syste i relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------ -------------------------- DATE----- e2 REVIEWEDBY-------------------------------------------- ---------------------------- -----------------•- ------------------------------ DATE------- BUILDINGPERMIT ISSUED-------- --------- ------------------------------------------—--- ---------------------------------- DATE-- -------------------------------- ------- Alterations and./Dy recommendation------- ------L---- --- ----•------------- �: - --------- ----------- f --------------------------- -------- - 1 -.........�-� - ----- ------------------------------------------------------- --------- ------ -• ---- -- ------- ------------------ --------------- ----------- -- -------------------- -------------------- - -I--------------------------------- - --------------------------------- , --- ------ ------------- - -- ------------------------ - ------------------------------------- -------- ----------- --------- ------ FINAL INSPECTION BY: ---------------- Date------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 30.5 West 9th Street Stockton,California Lodi, California Manteca,California7rpcy,California E.H.9 2M 1-67 vanguard Press