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" FOR OFFICE USE: -------- -------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ............. ------------ -------------------- ------------:,::--- _—__.-::., :-.- (Complete in Duplicate) 1 ----------------- L This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS'AND LOCATION__-94NT---�,_/-NC'------- ---- !\I--- ----------- �/ A3; JOB ..---- Owner's Name_VA11,t -------�"�1-4_�� f �-►-..------ ----- Phone--�-��- ----------------- ...... AddressW - _/t +C�l /�/. - ---..:- ---------- _ - 1 l I . Contractor's Name___________ __ Phone. _ ------- �- - - ... Installation will serve: Residence�V/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [��• sc�. Number of living units:,__.___ Number of bedrooms -At___ Number of baths J= size ---------------_--------------------------_----------------- I!Water'Supply: Public!system ❑ Community systerin ElPrivate eDepth to Water Table..�.�s ft_ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam Clay El Adobe[I Hardpan El" Previous Application Made: {If yes`date-------------- No New Construction: Yes ❑ No X FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION.,AND SPECIFICATIONS: (No septic tank or ces p of-permitted if public sewer is available within 200 feet.) A Septic Tank: Distance from nearest well----------------- Distance from foundation--------------------Material------------___------____________________________ { ❑ Noof compartments----------- _` $i --- ----........Liquid depth--.-- ----------------Capacity----------------------- Disposal Field:"-Distance from nearest well.l ...:.Distance fromfoundation__l5t.0_________Distance to nearest lot line__D___--____ I Numberrof lines------------/--------------------Length off--aach line__--_7Z�r --------------Width of french---------'3k=!K_-__.---------- l _ Type.of filter material._�FPaok ___'Depth of filter material--'! length----------------IAVO--___________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_"______________.Distance to nearest lot line-----.._-_-______ ❑ 'Number of pits------ ---------------Lining material-----------------------Size: Diameter:` .' _ ------Depth-.----------------- ------ Cesspool: Siizea D ameter near=st ell _ Deptht ce from foundation_ i_ F Liinund Capacity'---_- als. �. ... . �. �= E q P y` g �,,�,,,, —.-Distance from nearest buiidl g ---_------------7------------- El _____________ _ Privy: Distance.from nearest well________________________r--____ 7 . --------- ❑ r6sr., --- -------------------- Distance to nearest lot line---------------'-------- - -----------------------------------=--------------------------------------------------- .N -..� 333 Remodeling and/or repairing (clescribe): - - I------------••---•-------•--------•----------------------------•---------------------•------------=------------------- I ! - --------------------- I-------------=--=----i--------------- =_ =-----------------Z------- -----------------------------------------------•---- --- s d. I herebyicertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State law and rules.and.regulations of-the SantJoaquin Local Health District, f (Signed) ----C -------- ` -:--- I ' --------------------- ------------------------ --------------- --(Owner and/or Contractorl T By---- !-- E 2r - --•------L' ?--`- -- --'`- - ^c- - (Title) ---- - -- µ---- ----- - _ . (Plot plan, showing'siie of lot,.locationkof sy;tem., relation too wells, buildings, etc., can be`placed on reverse side). FOR DEPARTMENT USE ONLY APPLiCAT.ION ACCEPTED BY� ----------- ---------------------------------- DATE----------- --------------- REVIEWEDBY------------------------------------------------------------- -------------------------------------- DATE---------- � 'Y--------••---•------- BUILDING PERMIT ISSUED-------------- --:-------------- A ------------------- ------------------------ DATE Alterations and/or recommendations:'_': _______________ ----------------------------------------------------------------------------------------------------------------------------------------- - f a- -------------- ----- -1- - 1 ------------- -------------------------------- -- ------ ----- ----------------------------------------------- ------------------ ------------------ �. i4-.aw+rt.K- +�MF�.:�e.a �+`e• � ..r �-.. : .. r-..wr.-m.-u:a..._�.-. �ti..:�,,,,,w j��.T .,.ti,. FINAL INSPECTION BY----------- ------- ---- T---- - ---------. Date------------------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f ES 9 REVISED EI-59 3M 3-'63 F,R.00.