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o OR OFFICE USE: 3 G g -- -- APPLICATION FOR--SANITATION PERMIT rr ;Permit No.------------------------------- .cn_> _'!___ � (Complefe•in Duplicate) 1 This Permit Expires 1 Year From Date Issued - --------------- - �'--�a. � -- ----------- - - - 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 Ordinance No. 549. qtr JOB ADDRESS AND LOCATION- _`1"F•e-- ...... 1 -�t//1 ,� ---•-------------- ------------------------------------ ----------- �?- Owner's Name-_ e'7�--- - - - - - ---- ------- ---- -------- Phone.�?.,.1!-97Z� - ----- r Address . --- ---- ------------------------------------------------------------ Name /.. - - Q - -...f_..e._ �--------------------------------••--- Phone 7==Tcz• -_:-.�13__ Installation will serve: Residence�Apartment ouse ❑ ommercial ❑ Trailer Court ❑ �M/otel El Other ❑ } Number of living units: __ /_ Number of bedrooms _.7- . ._ Number of baths lak . ot size _-._/,� _ �' —_._.__._.__._.___.._____ Water Supply: Public system ❑ Community system '[ Private ❑ Depth to Water Table __.._-- - ft Character of soil to a depth of 3 feet-- Sand ❑ Gravel ❑ Sandy Loam ❑--Clay Loam 0 •Clay ❑ -AdobejX_ Hard p in ❑ Previous Application Made: (If yes dote_-_.._-..--_---_-- ) No El New Construction: Yes [jNo�FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tSeptic Tank: Distance from nearestell, �_�Q_-Distance from foundation-_--- - No. of com artments. size � '. �Li uid de th---_ _. _. `t capacity J. -Po- 9kp --- osal d: Distance from near�jst we ..-....Distance from foundation____k _ .._:Distance to-nearest lot line...�_�.----- v ' Number of lines.__._-1____ .__{_...�_ ....._Length of each line-- �`f --_ Width of french F ' .,.--De th of filter material....]-_- . cf Total length_____ ---- Q--`---------------- Type of filter i ateriaii�? p - - -- S a� Distance to nearest well____. Distance from foundation--_ ____________Distance to nearest lot line--.-_-_-__._----_ Number of pits--- ---------....,--!.--Lining material----"---------------- Size: Dia .- meter.---------.------ - --Depth--------- ---------------------- Cesspool: Distance from nearest well------------------Distance from foundation................. . Lining material----__-----------.-_---------.-..._.. ❑ . C V `-Liquid—Ca Capacity g aSize: Diametei- 16Deth «- " PrivY� Distance from nearest well----------- ---`----------------------- -------._Distance from nearest building- -- ls. --------------------------------- ❑ Distance to nearest lot line---- ---- - -- - -------- - ----------- ---------- --------•-•--------------------- --------------•----------------------- --------- Remodeling and/or repairing (describe}:--------------- ------ 3 '�N ------------------ ----------•-------------------- --}-----------------------•--------- --- ---------------••------•-----•---------------------------- --------- ------------ - i --------------------------------------------------------------- :----------- ----- ` --------- ------------------------- IF---------------------------------------- 1 t , I hereby certify that I have prepared this application and Aa the work:will be done in accordance with San Joaquin County ordinances, St e a�d rules nd regul ns -he San n Local)Health bistrict._ (Signed `� -----------(mor Contractor} , --- By:-------------------------------------------------------- ----------= �� - - --------------(Title). (Plot plan, showing size of lot, location of system i elation to wells, buil ngs, etc., can be placed on reverse side). t is j t FOR DEPAR .MENT USE ONLY. A APPLICATION ACCEPTED BY-"---------------- '- --- -------------- DATE----------- REVIEWED BY -----------f----------------------------- -- ----..-`- --------------- ---- DATE----------- BUILDING PERMIT ISSUED k ------- -------- i -, ° DATE. , -- ----------------- I Alterations and/or recommendations:._..--.----------------:........... '' _ ------------------ ----------'-LL- I --------------------------- - ------ ------------- � � --------------------- ------ ----------- --------------------------------------- .... ---------- - ------- .----------------------- - ------- ------------------------------------------------------------------------ -. - -- -- --- -- -- : ----- - ------ ---------------- ._...------------ FINAL INSPECTION BY:------U_ti-=L-r.._ 11---- - - Date_....- -Q. -- -- �.- ._._. . ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 I:.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 F