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FOR OFFICE USE: Q ---- ` q _- � APPLICATION FOR SANITATION PERMIT Permit No. W//zzr -------------- ..-- ---------- ----- --- ` (Complete in Duplicate) Date Issued -' ___=_ S� ---------------.___________----.__.--- ------------ This Permit Expires 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 described. This application is made in compliance with County rdinait`}q 549. JOB ADDRESS AND LOCATION.--=--- . ----- !p • Q Owner's Name_ 1.�/_. -�?'� -� �It_.._.. P ,F_��6_ofw •------------•----•------------- Phone-----d.':_ol_c_�-50. Address f *J .A-_1-A_1!?-0'rQ.. //- a-�-*_r ----------------------- ........................................... Contractor'sName •- ,, ..-----.6-0./t--- -•----------------•-•-------•---- Phone................................... Installation will serve: ResidenceV Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- ----- Number of bedrooms _a._ Number of baths-l----.- Lot size ____.t ---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 10.0 ft Character of soil +o a depth of 3 feet Sand ❑ Gr I ❑ Sandy Loam ❑ Cla oam ❑ Clay ❑ Adobe Har n ❑ `\ Previous Application Made: (If yes,date----------_-___.__ ) No New 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.) ..,�. Septic Tank: Distance from nearest wel�l.}.�_�l- ----Distance from foundation--- � Material ACLV.._�.r�Ac No. of compartments__._-_s6.__._-__�__.-Size__2-_x'a7-_'7 __Liquid depth._., _______ _______Capacity_._.d--�lo__ ",,,,Disposal Field: Distance from nearest well._b .......Distance from founds on._f/.1�__-__-__.Distance to nearest lot line__ -------- 4/p -___. Number of lines-------- --- Length of each line__ ..Q Width of tren ��G 9 ------------ Type of filter material_..R,DG -___ ___Depth of filter material__1.Q.__. Total length__ ................................. i l eepage Pit: Distance to nearest well___ ...-.-.-_.Distance from foundation.10--------------Dis4nce to nearest lot lin fe.1®___.___.._ Number of pits._/-. -------------Lining material._od_C*-_.__ Size: Diameter.,-.__...-----------Depth___ ____________________ Cesspool: Distance from nearest well ................Distance from foundation----------------- _.Lining material------------------------------------- r_1 Size: Diameter- -- --------- - --- ------ ---------Depth------------------ ---------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------_-----------___Distance from nearest building---------------------------------.---.-._. ❑ Distance to nearest lot line--------------- -------- ------------------------------------------ ---------------- -------------------- -------------------------------- Remodelingand/or repairing (describe):---- ----------- ---------------- ------------------------------------------•------------------•------------------------------------------------•--•---- -------------••--•--•---------------------------------------------------_----• --------------------------------•----------------- ------------------------------------------•---------------------------•---------- ------ ----------•---------------- ------------------•--------•------------------------------•----•--•-----------------------------------------------------••---------------- •---------------------------------•- ----------------------- ---------------------------------------------------------------------------•------------------------------•----------------------------------------------•----•----------------------------------- 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!egulaticMof the San Joaquin Local Health District. Signed _ ---------------- -----------(Owner and By:----------------------_----------------------_---- ----------- ------------ ---------- ------------------------------(Title)---------- ----- ---------------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -yF�OR DEPARTMENT/USE ONLY APPLICATION ACCEPTED BY-----1_e--Z------f A---0_-r-r-d-- E----------- -------------------- DATE--3' 1- �p ` _---------------------- REVIEWEDBY------------------------------------ ------ -- -------- -------------------------------------- ----------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------_- ------------------- DATE--------------------------------- -------------------------- Alterations and/or r mmendations:.r...... ........___..__.__ .. _ _ _..._.____ - -- - - - -- - - - -------- -- --- --0-cl.-K�� y"------ -.....J- J-�`` -� ! / v !1 y lGf f 1�ee FI AL INSPECTION BY:. - - ------- Date .,.--��('.,-. Qi. �QUIN LOCAL HEALTH DISTRICT j 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press