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r+ FOR OFFICE USE: --------------------------------------------------------- ., .. // ....................................... ............. APPLICATION FOR SANITATION PERMIT Permit No. 12.1,212J,1.111 ' ----- - - -- -- ------- --------- (Complefe-in Duplicate) ... ................................_.....--------------- i This Permit Expires 1 Year From pate Issued Date Issued ---------------------- �J 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- Owner's OCATIONZQ. �+ Vis- Owner's Name sC1et fid/ / - - ------.-. Phone----------------------------'---•--- ---------------------------- Address_ � --------- t i..y` -'rI- / �-------------------- ------------------------------------------- ----- ----------------------------------------- ; Contractor's Name--- C�.... .� :�� -- _ � --�Qj,�� Phone �: � Installation will serve: Residence Apartment House ❑ Commercial Trailer''Court ❑ Motel E] Other E]Number of living units: .,.... Number of bedroome�-. Number of baths./-'4Lot size ----- C6_et. ---_- 4 yF. Water Supply: Public system ❑ .,Community system ❑ PrivateDepth to Water Table .-..-. ft _ ( Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑-'Sandy Loamlay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Ah Previous Application Made: (if yes, ................ I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No°septic+an'or cesspool permitted if public sewer is available within 200 feet.} 1 � ! I Se tic Tank: Distance from nearest w IIP.-.Distan fro fo ion.-- _.._.Material . �0./X -F� ............... No. of compartments.. ..............._Size. ._. ___- ..Liquid depth_.-_1.T6_.9--------Capacity......__-__...-......-. r � Disposal Field: Distance from nearest w0.jv7Q.f...Distance from foundation.. , --. _._.,Distance to nearest lot line...-.ZVr - -- i [ Type of filter matenaL Depth'of.filter material_-/ = ..Total'length=....--_-- .�� ------- e ` Seepage Pit: Distance to nearest w.O—.2^'---`_�6 Distancfrom foundation--._"............. Distancef to nearest lot line.........--..--,. ❑ Number of pitsi.- --- ..........Lining material---- -,r.........:...Size:-Diameter-------------r--,- ---Depth--------------------------�- Cesspool: Distance frorri,nearest well -----------------Distance from fouridatian--- ........... ..Lining material_____-......------------------------- - ----.-.__.__._-. ------. ❑ Size: Diameter--- --------- ----- --- ----- Depth= <t--- .. -----------------------------Liquid Capacity----------------------------gal . Priv Distance from Barest well------------------------- ---- __Distance from nearest buildin f, � ----- -- -------------- El -- - 4 crest lot line --------- -- - -- - + g.x ----------------- Remodelingand/or repairing odes' F' 1 � , s i ----- ---- - f / --1 -- ---------- ------ ------------------ --------- ----- _ _ __ _ y y pre acid this a lication and1hagt the~work will,be done in accordance with San Joaquin.County ! hereby certify that I have ;r p t pp �nty ordinances, State laws, and rules aAd re 'ulations of +M�San Joaquin Local Health District. I 5i ned -�-�� t ( 9 -------- ------- ------ ( r ' '------------.(Owner and/orf Contractor) g -� ( t _ ` y:.... - ------------- ----- -------------------- ' ` ._.(Title( -- . . --------- ---------------------- r [Plot plan, showing size of lot, location of system in relationto well, buildings, e+c., can be placed on reverse side] FOR DEPARTMENTUSE ONLY APPLICATION ACCEPTED BY T - - ---- `� -- -- ----------- - ------- - ---- -------- - DATE..-^Y-6 --?------ - ---------- ----------- -- - REVIEWED BY -- ---- - - i- ! - -- '- -- ------ DATE----------------------•----- 4 BUILDING PERMIT ISSUED'----- --7-------- -------- -'`---------------------------------------------------------------DATE_-r - Alterations and/or recommendations: - -------------------- -----�', -------------- ----------------------------------- ---------•-------------------------------- C ----------------------- # .I , t i Z --- -- •---------------•----------- ------- ---. ----------------- ------- -----------, FINAL INSPECTION BYA. 4�r -------- Date.-d- 0- ��' ----- f �/ ! SAN JOAQUIN LOCAL HEALTH DISTRICT r - f 1601 E.Haxeltan Ave. } 300 West Oak Street 124 Sycamore street 205 West 9th Street I Stockton,California Lodi. California — Manteca,California Tracy,California F.H.9 2M 1.67 Vanguard Press