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FOR OFFICE USE: ---- ------- Permit No. --------- ----- - APPLICATION FOR SANITATION PERMIT - .. V - _ (Complete•in Duplicate) Date Issued ------------- - -_-_ This Permit Expires 1 Year From Date Issue 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. i� --------------- JOB ADDRESS AND LOCp,TION-___ly----------- - _ Phone Owners Name. ------- --- ----- y ��0z.[�.11`_ ------ -K------ ------ ••-- --- �- ° '"; � ---- --------_ �-r-� �-� ------------------ - ---- Phone---------•------* rn +4� Con#radar`s Name__. -- ---�'�f" '�--------- - - --- ------ r------ ------ ----- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other [ » 111- Number of living units: -/._-._ Number of bedrooms . Number f baths_ -..._ Lot size _____ ___ ________ __ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand E] Gravel [I Sandy Loam 0 Clay Loam Clay E] Adobe❑ Hardpan C] Previous Application Made: {If yes,date_------------------ ) No E] New Construction: Yes E] No E] FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND:SPECIFICATIONS--- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearesf well_.-..:_-__.Distanc� from found ion.-fa_/-- -- Material ._-__'�+*��-------� No. of compartments------ �f Size_,_-- �� d!- ---Liquid depth------7 ---- --------Capacity---� 7----/� Disposal leld: Distance from nearest well-- .fQ._.._Distance from foundation---lQ--�-- -..Distance to nearest lot line ___.._. Number of lines ----------4 -------- ----------Length of each line-- _�.----------.Wid#h of }ranch._ "..`.-----=------------------ -- Type of filter material-___.. i - -------Depth of filter material...... length----/9±�------ -------- ` ptJ,..._----Distance from foundation__la.`'_-----Distance to nearest lot line-Jr -__-... Seepa Pi}: Distance to nearest well--- Number of pits--- ------Y,-_---Lining.._material.:---5A'-- Size: Diameter 9 - .Depth------�`s-- ------ I f Cesspool: Distance from nearest well _--------------Distance from foundation-.-._-- ---__. Lining material__-_.....__-..- - als. Size: Diameter. . ---- ----Depth_.�Y_-_--- . Liquid Capacity.-- ---------------------- 9 ��-- - ---- --- Distance from nearest building---------------------------------------- Privy: Distance from nearest well��""F-___..-__,______________ _ , Distance to nearest lotdine.-_-".-________________ _ ------------------------------------------------ El ---------------------------------- Remodeling and/or repairing {describe)-------------------------------------------- ------------------------------- ---------------------- ---------------•------------------•------------- ------------------------------------- ----------------- ---- ---------- --------- -- ------------------------------------------------------------------••------------ ---- ------- ---------------------------------------------------------------------------------------- I hereby certify that 1 have.prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f _ - ---------- ----------------- - ------- -- -------- --- -- -.b.,. (Signed} -- ------- -,�.�."".e...itl Qwner� _ .and/or Contractor BY , . ovation of s sterr}lin - - (T� e) (Plot plan, showing size of lot, I Y relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - -- --- -------------------------- ------------ DATE_/b-�� 'r REVIEWED BY-------------------------------------------- --- - --------------------- ---------- -------- -- ----- -- -- DATE----- ---------------------------------------------------- BUILDING ---------------------------------------------------BUILDING PERMIT ISSUED-------- -- ------- --------- ------------- ---------- -----•------ ------- -------------------- DATE----------- ------------------- ---------------------------- Alterations and/or recommendations------------------------ --------------- ----------- FINAL INSPECTION BY: ----- ----------- Date------4 0 �7 ^�♦ ---------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 16o1 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Califarnia Lodi,California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press