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FOR OFFICE USE: - �~ ----- ------------------------ ---- :---- -------- to I ., APPLICATION FOR SANITATION PERMIT Permit No. -------------- --- -----_ --_ (Complete-in Duplicate) j / Date Issued This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrl`bed+ This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__1_96././.,E_y_iif--IA @ ''' "` ------------------------------------ --------- -•------------ Owner's Naam77e---C_.R--- ---------- --------------------------------- ----------- -------- Phone-------------------------------•-- 1C Address._.•-tJ-•- ot__]( F-. - ------------- ------- -- •- ... Contractor's Name---- s. ---- ---- Phone Installation will serve: Residence [Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms __Number of baths.-1____ Lot size _____ __ -------- -------- -------------------------_______ �.;• Water Supply: Public system 5KCommunity system ❑ Private ❑ Depth to Water Table ------ _ ft [ 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 ❑ New Construction: Yes ❑ No.[] ._ FHA/_V.A:Yes_❑_ ,No ❑\�� TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_-Vin .__ _Distance from foundation-_.../ -s--------Material _ _________ ______.____.__ _____.._...._____. No, of compartments_..__'r9—__._--------- - -`!r- :_Liquid depth-...Li ....... ........Capacity.._F6Q Disposal Field: Distance from nearest well---0 Distance from foundation___{1_ !___._.Distance to nearest lot line ___.- le Number of lines.---------I-----------------------Length of each line- --- of trench----X-_------_---------------- Type of filter materialu_._S.Z-._.-----Depth-of filter material-----/.�...`.r-----Total length_____ .4' 1 • Distance to nearest well.__.-fCW.174--Distance from foundation----d,P._/----- Distance to nearest lot l ❑ Number of pits._ ____ ___________Lining material--:-: .. Size: ,PvuL]ia�ater_ - /Qepth___ --._.-__-_.._ Cesspool: Distance from nearest well ________________Distance from foundation...............:. ..Lining material---------------- -------._-.-__-_-_3� 1❑ Size: Diameter - ------ - ----- --------- __Depth----- --------------- '` J - --- ---Liquid Capacity--------------------------gal Priv Distance from nearest well .......................--------.... .Distance .from nearest building ______________.__-. ❑ Distance to nearest lot line ..-------- ---- -------- --------------------------------- ----------------------------------------------==--------------------- I Remodeling and/o re airmcribe); te - .XJ.S'Tll �'� �1?- 1 ------------------------ --.---_-------- ----------------------- -------------- '=---------------------------------------------------------------•-------------- ------------ --- : r ------------_------------- ---- -----------__- ..._._... I hereby certify that I have.prepared +his applica+ion and that.the work will be done in accordance with San Joaquin County ordinances, State.\laws:-and'rules nand regulations of the San Joaquin Local Health District. (Signed) ------=-- - --------- --- -- --------- .�wer-end/or Contractor) (.i� = ---------- --- ------------ (Ti+le}_ By:--- --- - - --- --- ------------ ------------------ ............------------ (Plot plan, Jing size of lot, location of system.* relation to wells, buildings, etc., can be placed on reverse side). 01 - :i. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- !� - ------------------m------------------- -------------- DATE-Y P------------------------------- REVIEWED BY-------------------------_-- - ----- ---- - - ------ ---- ------------------------------------------------------ DATE------------------------------------------- --------------- BUILDINGPERMIT ISSUED---------.M------------------------------------------ ---------------- ---------------------------- DATE----------------------------- -- _ Alterations and/or-recommend ations__________________ ________.. :IM' ---------------------------------- --.. --------------------------- ------- ------------------ - - ---------- ----------------- -------•--- ----------- -- ----•-- -- ---------------------------------- .................... -------------------- ------------------------------•-------------------- ------------- --- !l- ................ ----- IN FINAL INSPECTION BY:_._ ------ ------ Date__��.f_ '. .................................................... - °`__....._......_......_..._._....__..-_..... - SAN JOAQUIN LOCAL HEALTH DISTRICT % u 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th.Slreet t k Stockton,California Lodi, California Manteca,California -Tracyr California E.H.9 2M 1-67 Vanguard Press