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/ FOR OFFICE USE: ----------��/Q----- 19 -------------__-_-.-_ APPLICATION FOR SANITATION PERMIT Permit No. .�a.....a.. ------- ---------------jU`` 5 (Complete-in Duplicated - 3�_ ---------__.-. ._____/!��S This Permit Expires 1 Year From Date Issued Date Issued ___________ ___ ,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 ADDRESS AND OCATIONNC,...�sa?76_,0i-(Gi r 1-�=2� ------------ ---------------------------------------------------------/--------------- Owner's Name- ��LGi r-.!!._1_- --- �------ •------- ------ ----- Phone,_ 6__ !_6/ --- Address............................ ---- -------------------------------- -- --- -----------------------------------------------------------------. ........................................... Contractor's NameJF: k1F1c ?Gc------------------------------------------- Phone.:51.'- 57��.-- Installation will serve: Residence 6--A—pairtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑_/ Other ❑ Number of living units: j___ Number of bedrooms _ __-_ Number of baths_/__ Lot size 1.1�,�_f__7�___ �_r______-_--_-__ Water Supply: Public system 9 Community system E] 1- tPrivate ❑ Depth to Water Table . t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 05, Hardpan ❑ 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.) *�ti nlf: Distance from nearest well__--__Distance from foundation--------------------Material -----------------------------------.-____-_____. No. of compartments------------__----------Size--------------------_________ Liquid de th-___-_-_- _ Capacity ------------- f F D' osa Fie-1 Distance from nearest well . j&-' :_Distance from foundation-,--Q.--___.-.Distance to nearest lot line___ /� Number of lines-.'../ ________________-Length of each line_____,(!_'...-__-_._.Width of trench.,-_Z5 �!__Y_- �4( `\ Type of filter materia _--__Depth of filter material------,1 ��___-Total length___________________ -�__..____ Seepage Pit: Distance to nearest welL_. � --Distance from foundation_ _D.�.___.Distance to nearest lot line____.ld_-. Number of pits_.I--------------Lining materialRO_ _------ Size: Diameter.—-----___-Depth-.�a �_________________ Cesspool: Distance from nearest well ________________Distance from foundation-------------.___ -.Lining material__----._.___--.--__-___._--__-____--_ ❑ 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)____ _____ ____ . . ____ ___ t -------------- _ ----- __------- -------------- ------- ----------- - f ---------- f ---------- - -- ----- ----- Yc -----------------------------------------------------I---- ------------------------ ------------- ---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lwaand rules and regulations of the San Joaquin Local Health District. (Signed)--- -- �' � }A �' __ Yom' -- ---{ ontractor) BY:------------------------- ---------------------- / `'fin-' t ------ ---------=--------(Title)---------------- ---------------------------- ------ --------- (Plot plan, showing size of lot, location of system in relat' n to wells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----------------------- --------------------------------------------------- DATE----- ` 1 ------------------------ REVIEWEDBY------------------------------------------- ---------------------------------------------- ------------------------_- DATE------... BUILDINGPERMIT ISSUED------------------------------------------- ----------- --------------•--------------------------- DATE--------------------------------- Alterati ns)and/or recommendations----- ------------------ --------------------- ---------------------------------------------------•---------------------------------------------------- fy � /1 . -- --------------------------------------------------------- ----- -------------------------- •------------------------------------------------ r / � ---- iz c.c� o]. r r - 6 !y............. -- - • =`........ " ---- -------------------------•- ------.... -•-•-- _ - - ---- - FINAL INSPECTION BY:------...... ------------------------------------ Date.------ ----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton 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