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A.. FOR OFFICE USE: j ------------------------------------------------ APPLICATION FOR SANITATION PERMIT O�Permit No. ------------------------- ------------------------ ------ (Complete in Duplicate) "V f � This Permit Ex tree i Year From Date Issued Date Issued . ---- d_._.l/..4/ _ --------------------- ---- -----------_____._____.__. --2Ap`plication fis,herebyFm�ade 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. -' `f -REWlZ JOB ADDRESS ANDO/l -------- ------ //- Owner's Name------- _�1-- - _'T ..._ 1 D_n%-----------------.----------------------•----------------------------- Phone Q.. Address------- ." % # Q ----------17 6...------..4 Contractor's Name ------- -��__UAW-P.. •---------------- y - -" •------------------- Phone. Installation will servResidence ❑ Apartment Hous[] Commercial ❑ Trailer CourtM�ot11"j] her AJ Q If E�Number of living units: ___ Number of bedrooms . t!J__Number o bather Lot size _ - ..�------------- -- -`-' Water Supply: Public system E]Community syst ❑ Private VDepfh to Water Table ._ ___ ft. _l0 Character of soil to a depth of 3 feet: Sand Ei Gravel ❑ Sandy Loam ❑ Clay Loam ❑ by ❑ Adobe ❑ Hardpan ❑ 4 - . Previous Application Made: llf yes, date __--- - -------) No �ew Construction: Yes No ❑ FHA -/VA: Yes-❑ - No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepank: Distance from nearest tic well_3OO---_ Disty_) e from foundation. ...a -------- Mairial--- _ � I_oaD------------- X __ Liquid depth --.--_------ --------- Capacity... AS - No. of compartments________ _____ ______Size Disposal Field: Distance from nearest well --- Distance from foundation____. _ ___.Distance to nearest lot line____ Number of `lines_...,_ ��_________ ______________ Length of each line___"- Width of trench.-_ Type of filter'ni"aTerial____ QC `_--Depth of filter material_ 3 -pt ---- Total length ........ .___ ______-&�____ Seepage Pit: Distance to nearest well _____________________Distance from foundation _._..________-_-___.Distance to nearest lot line --------- ❑ f Number of pits ------- -------------Lining material ---------.------------ -Size: Diameter ----------------------- Depth --------------------_------ Cesspool: Distance from nearest weil----------------- Distance from foundation --- _---------------- Lining material-__.___--_-_______..______________--.� ❑ Size: Diameter------ ------- Depth --- ---•--------------- - ---------------------------- Liquid Capacity --_---------•-----.-------gals. f Distance from nearest building-_. Privy: Distance from nearest well g ❑ l Distance to nearestlot line ------------------------------------------------ ----------•------._........----------------•--------___ ----------------------------------- Remodling and/or repairing (describe):-------------------------------------------------------------------------------------------------- ---------------------------------------------------- --- I --------- I ............. ------------._.---------------•---•-------------------•-•----------•------------------------------------------•---------------------- •------------------ ---- --------------------------------- ---•------------------------------------------------------------ 1 t ---------- ---------- ---------------------------------------------------------------------------------------------------------------•-...--------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to a laws, and rules and regulations of the San Joaquin Local Health District. {signed}. +------------------------------ Contras �.�,.►t - _ _ . _ =and/or tor) TitleBY� -------------------------------------•------------------- (� ) F --- --- -------------- (Plot plan, showing size of lot, location of s;stem in relation to wells, buildings, etc., can be placed on reverse side). " ��► `�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ' 0 --------------------------------------------------------------------- DATE ------- ,95__ --------------------- REVIEWEDBY -------------------- ----------------------------------------------------------------------------------------------------- DATE_ ---------------------------------------------------------- BUILDINGPERMIT ISSUED --------------------- ----------------------------------------------------...------------------------- DA•TE_ --- Alterationsand/or recommendations:---1----------------------------------------------•----•---------- ----------•-----------.._..----------------------------------------------------•------- ----------------------------------------------------------------- I-------------------------------------- ---------------------------------------------------------- ----------- ----------_-----•---------------------- -------------•------------------------------------•---------------- - --; .._- __ _-----•-•-------- ------------------------ ^' !i -------------------------------------•---------------•--- ------------- -------------------•----------- --=-----------;.`;� ` > >t : -----•-••-------------------------------------------------------I-•-•------- FINAL INSPECTLO,N 8 -= --- -- -- - -- -------------- Date ------AV------ --------- 41 ---------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E6-9 REYIEEO 8-59 r.P.LQ. iM 6.66