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FOR OFFICE USE: .. % - ------------------------ ------------ APPLICATION FOR SANITATION PERMIT Permit No. - ---------------------------------------------------------- (Complete in Duplicate) Date Issued ----------------------------------------------------- This Permit Expires I Year From Date Issued Application is hereby made to fh� San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in com.2-Ii with County Ordinance No. 549. ,e OT*r 0'ej -A JOB ADDRESS AND LOCATION............ -------------0-----------5-rr-_3eF,-F------------------- /------ -rHFoT>---------------------- ------------- Owner's Name-----------Pt1_1_La-nj4,F>_!s---------co-Ni -s-r.--------�2... ------------------------------------------- Phone------------------------------- Address---------------- 4632=.�7------- ------ ------------------------------------------------------------------........... ----------- Contractor's Name-----Ot-W. W- ........... --------------------------- ------- --------------------------*-------------------- Phone------ ---------------------------- Installation will serve: Residence '� arfment House ❑ :Commercial E],.-,-Trailer Court L] Motel L] Other ❑ Number of living units: 'Number of bedrooms --- Number of ba..t.hs2—.- - Lot size 01 ------------------------ Water Supply: Public system �mmunify system E] Private E� Depth fo,Water Table ft Character of soil to a depth of 3 feet- Sand L] Gravel E] Sandy Loam 2111clay Loam F] Clay E] Adobe E] Hardpan F] Previous Application Made: jIf y6's,date_...__..._--.._.... I No,�New Construction: Yes�o E] FHA/VA: Yes ?I No E] --"i-TYPE�OF 1NS TALLATION-AND SPEC IF[CA-TIONS:--= - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se k: Distance from� nearest Dis-fam;e from foundation---10----------..Mate __C0A1.CPtjFTM----- pe No. of compa.rtments S-,ze__4tX_10 Liquid deptk-- 2-- --------Capacity----/x049 - --------- p Field: Distance fromi nearest well... ..Distance from foundation----/40----------Distance to nearest lot hne-----2 ... Number of lines ------- ------------Length of each line-- ------------- Width of french. .362---�f-------r-------- Type of filter paterial__4RO---C145--Depth of filter maferiaI_____j4j---------Total length---------------4po-------------- Seepage Pit: Distance to..nearest well------_-------------Disfa.nce from-founciation--------------------Distance to nearest lot line----------__---__ El Number of pits... ..................Lining material--------------.------- Size: Diameter-,--------------------. Depth----------.------.-_-----_------. Cesspool: epth------------------------ -------- Cesspool: Distance from nearest well ---------- Distance from foundation___ ------- . Lining material_..__.______-__---___.-..____._.._ Q ❑ aterial-------------------------------------- F-1 Size: Diameter. .. ......... ..... .... ------------Depth------------------------------------------------7--Liquid Capacity_ -------------------------gals. Privy: Distance fromi nearest well-...............:...............................-.Distance from nearest building_------ --------------------------------- El Distance to nearest lot line ............ '•----------------------------------------------- - - --- ------ ----I ,a , -------------------------------------------------- —7 Remodeling and/or.repairing (describe):------- :a ---- ----------- -------------------------- --------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---- --------------------------------- 3 -----------------------------------------------------------------------------------------------------------------------------•-- ' ------------------------------------ -------------------- --------------------------------- ---- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby-certify that I have 9repared this'application and that the work willk;e done in�accordance with San Joaquin County, ordinances, State laws, and rules and regulaf,ions of the San Joaquin Local H6alth,Districf., ---------------------•------------------------- --- - ---- ------------- - -- ---- -------I---------------------------- ----------------- ----------- ---- ............... (Signed)-------- (Owner and/or Contractor) (Plot plan, showing size 0 t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USEONLY—*� APPLICATION ACCEPTED BY._ � "z---------------- ------- --- ------------------------ ------ ------ DATE------ - -------------- - - REVIEWED BY--------------------------------------4� ------------------------ ----------------------------- ----------------- --- ------ DATE-------- --- BUILDINGPERMIT ISSUED-------- - --------------------------I----------------------_----------------------------------- DATE._ --------------------------- ---- - ---------------------- Alterations and/or recommendations:...t10 I-M ON.S......OF L.F-A--W... C-OVER�1:i-----iffa_ ............ ------------------------- ---- rlwn.C�7 ----------------------------- ---------------- -- ------------------------------------------------------- -------------- ------- -------------•---------- --------------- ------------------------------------------------------------------- ----------- -------------------- ----------------------- ------------------- -------- ------- ---... ............. ----------------------- - ----- ----------------- ——----------------------------------- -----_ .............................. ------------------------------------- ---------- --- ------------- . .. .. ...... --------------- --------------------------- ------------------------------------------- FINAL INSPECTION BY Date.------- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press