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F R OFFICE USE: -71-------------------- - QQ APPLICATION FOR SANITATION PERMIT Permit No. ............ --------------Ad- (Complete-in 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATIOf4!-�.JJ �Q"''0 `t-�.R..-�C� --------- -A.-Y--------------=5- Owner's NameLJ 014--N-----•---)ZERE------``..- e------------- ------ -- --------------------------- --------- -�Phone---------`------------•------•-------- Contractor's Name---- + T ---- --- l ----------------------- - ------------------------ -------------- Phone4k&_32`."'..•1•---- Installation will serve: Residence ❑ Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other 54 QLAN7— Number of living units: _ ----- Number of bedrooms -------- Number of baths-------- Lot size _-Ar_-/_J_;Z . .......................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tableho- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe$ Hardpan ❑ Previous Application Made: (If yes,date------------------- ) NoOKNew 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -----..-_-_.-.--.-..--..-..-.------.._.-_-.-..-. ❑ No. of compartments------------ -------- ---Size------------------- -----------Liquid depth--------- ------- ------- Capacity----------------------- O Disposal Field: Distance from nearest well-----------------Distance from foundation--..................Distance to nearest lot line_-.._.-._...-.--. � ❑ Number of lines-------------------------- -------Length of each line.. ---------------------------Width of trench--------......_.-..--_.-.-._------ Type of filter material _--__---.- ---------Depth of filter material-----------------------Total length.......................................... Seepage At:-- Distance to nearest well.....___-------..Distance from foundation....................Distance to nearest lot line----------------- 1-71 Number of pits---------------------Lining material------._.-------- --- Size: Diameter_-------------------Depth-....._-.--__._-----_------- Cesspool: Distance from nearest well ................Distance from foundation---------...----- -.Lining material-------------------------------------- F Size: Diameter- -- -------------- ----------------Depth---------------------- ---------- ----------------Liquid Capacity-------._--------_------gals. Privy: Distance from nearest well ---..-__.__..------__.--------- -------------Distance from nearest building----------------------........._--..._. ❑ Distance to nearestlot line -------------- ----_---------------------------------------------------------------------•---------- ----------------------------- �` ® it Remodeling and/or-repairing (describe:. _PjLA�r. _ -----A--'1.-- A_._..4000 -.... ....---•--.DAA•I - --------------------- - ------------ ----------------------------- �------------- - - I hereby certify that)Irhave prepared tis application and that the work AC be'done in accordance with San Joaquin County ordinances, State law`s, a rules aN reg ations of the San Joaquin Local Health District. (Signed) -- _ (Owner and, o"r .Contractor)ra- ctor )" _.--- By:--------------------- --- --- --- ------- /----- (Plot . -(Plot plan, showing size of lot, location of system in relation to wets, buildings, etc., can be place reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---- -- -------------------------------- �O �0 7 - DATE ----- 1 ---------- REVIEWED BY----- ------------------------------ -------- -------------------------------- ------------------------------------------- DATE----------------------------------------------------------DAT -- BUILDING PERMIT ISSUED �� D7� - A- -.- - .� E Alterations and/or recommendation -. -. --_- ------------------- -- ---- 0 ....... -- ��' t -... ---- ----- -c ...1z ---------- --- - ----- ---- ah..�• � 1 - ' -------------------I----------------------------- ----------- ---------- -------- ------ FINAL INSPECTION BY: - ------------ -------------------- 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 E.H.92M 1-67 Vanguard Press