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FOR OFFICE USE: r --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ ..-3 ;_3.7 ------------------------A it ------ --------- (Comple+e•m Duplicate) Date Issued ___-_------__.--- ---.-______-_ .__-_-._-._- 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 ith County Ordinance No. 549. 22-1! 2 S p A� JOB ADDRESS AND LOCATIO Sj 1.I R O j ----------- PN ' ----- - Owner's Name----------. —---------- EBR_l4 N `- ScoT T utrr�r ' Phone... ---•-----•--------- Address. Ps- /4r _G7111D I — hWl4f E 4 I---------- -- ------•--- Contractor's Name----C"1UV1.t _6- ---------------------------------------- --------------------------------------------.- Phone................................... Installation will serve: Residence ff' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms .2-.. Number of baths_ ----- Lot size __&9 RF0_G:_!^-------------------------- Water Supply: Public system ❑ Community system ❑ Private E"Depth to Water Table 1C_ ft Character of soil to a depth of 3 feet- Sand E�' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- ----._.-. ) No New Construction: Yes ❑ No Wr/ 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 well ................Distance from foundation--------------------Mate�ial-_.-_.-___--_.__.-_----.:-__-__-_--..--__.___. j\0't N & No. of compartments-------------------------Size-------•- -----------------Liquid depth--------- -- ---- ----.-- Capacity-•-•-------: ------ Disposal Field: Distance from nearest well----- ---_Distance from foundation_--I.0'.......Distance to nearest lot line......------- N r X i-inlC.r Number of lines________f__.___._-.-._.__-_.__Length of each line.._.-__�._- __.._.____._.Width of trench_____._�,.'}.._��_______________ •f--�D D Cc- \ Type of filter material-_ _.`--_) \---.._Depth of filter material-._-._j!/.........:Total length--------------- _______________ � Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits-.----------- .......Lining material------__..---------- Size: Diameter__--_---_-_----.___Depth--------------------------------- 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 ------------------------------_----------------------------------- -------------------------------------------------- ------------------- Remodelingand/or repairing (describe):---------W-------------- ------------------------------------------•--------•----------------- ... .................--------------•--•-------_----- --•-•-•---------•---------------------------------•------ -------------------• --------------•---•-------------------------------------------•--------------------- --- ----------------------------•----------------------- ---------------------------------------------------•----------------------•--- ----•--•------------ ••------------------------------ --------------------------------------------__1--------------1_1------------ I --------------- -----------•---------- --•--•------------------- I hereby certif tha#hhe prepared this application and that +he work will be done in accordance wi+h San Joaquin Coun+y ordinances, Stat_ v�s� nnd re at' sof the S Joaquin Local Health District. (Signed)------ - ---- ---- ------ -------------- ---------- ------------------------------- ------------------ ---------------- -----(Owner and/or Contractor) By:------- ---_----------- ------- ------- ------- ------------------------------ - --- ---------- -----(Title)-- -------- ---_ - - - - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ (i= ------------- ------------- ---- ------ DATE----------3- ---' -C-----6 ---------------- REVIEWEDBY--------------------------------------------------------------------------------------------------- ------ DATE--------- ---------------------•---------------------- J BUILDING PERMIT ISSUED--- -------------.- DATE---------------------------------------------------------- 1 Alterations and/or,;recommendations:-.-------- ------ ------ ---- ----------------------------------------------- •------------- ------------ ----------------------- ------------------------------------------------------------- --•-------- --------------------e-----------------------------------------..................................... ------------------------ ------------------------------ ------------ --------------------------------- ---------- ------------------------------------------..--_--------- ---------------------------- ----------- --- ----- - - - Date------------------- '_.'� ......----•-.------------ FINAL INSPEC :.. . . - - .��--- ------ --- --- --- -- ---- � -- - --- 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 E.H.9 2M 1.67 Vanguard Press