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�- FOR OFFICE VSE: _ D --------------------------------------------------------- q -_ __ _......................................._-._.-.. APPLICATION FOR SANITATION PERMIT Permit No. . - -.....�J.../ 15-1 -------------------------------------- --------- (Complefe•in Duplicate) 6/�5( . - 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 co pliance with County Ordinance No. 549. l7Qnl JOB ADDRESS AND LOCATION--------------- -- -�?- - .-- F�CfF-- d1 --'------ Owner's Name------------- !'l T°" •---------� /`� ' ------ --- ------------------------------------- ----- Address ---- Phone - Address-----•--•---------1-1.1al----------7------- > 1 1 ------------------------ - ------ --- ------------------------------------------------ Confractor s Name----'Q ^1ER-------................. --------------------------------------------.-. Phone------ •---- ---------_--- Installation will serve: Residence 0--"Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑I Number of living units: ---- Number of bedrooms Number of bath's.� '-Lot size ..... ..12�..��.fir..-...�.................... Water Supply: Public system ❑ Community syst �rivateDepth to Water Table Ja. 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------------------- ) No)2--_`New Construction: Yes - to ❑ FHA/VA: Yes [] --No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ F - —(Noseptic.,tank-or cesspaol-permitted-if public-sewer..is-available within-200-feet:) Septic k: Distance from nearest well---4.-�_Distance from foundation.--_ .0---.-_.Material ----CQ J.C-1kEME-F— -.-. P No. of compartments-.'74,- ----- _-Size-.�A_j_0-X.Co_Liquid depth..--- .-�.�__-Capacity-..- Disposal Field: Distance from nearest weli__C..S.><1_-.Distance from foundation-----t©-------.Distance to nearest lot line----------------- � ❑'_ Number of lines ---------7-- -_.___.-.--...-_Len th of each line_..- r r 9 gh...`� Width of trench Type of filter material. .�'�E��....Depth of filter material------.1.. ...........Total length.............,r!t>G�1� .._.-_-_........ 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_....-.-..------------------------- F1 .------- --_ - ❑ Size: Diameter- -- -------------- --------- ------Depth--------------- ............. ......................Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.------------------.-.----------------.--- ❑ Distance to nearest lot line -------- ----- -• -- - - - -------------------------------•--- ----- - ----------------------- Remodeling and/or repairing (describe):------------------------------------ d -----------------------------------------------------------------------------••--•-------------------------------------------------------------------------------------------------------------------------------------- - - ---------- ---------------------------------- ---------------------------------------- -------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Owner and/or Contractor • _ •----_•-------• ---.- ri _ BY •------------------- (Title)-- —(Plot plan'showing size of lot, location of system in Felatio'n-to"wells;-buildings,'etc:,can be placed-on reverse side) "'�'"�`" f FOR DEPARTM USE ONLY k APPLICATION ACCEPTED BY--- S..Z_0'- -- ------- ---------------------------- ------ DATE------------ ~-1------- 6/-------.- - ---------- REVIEWEDBY-------------------------------------------------- - --- - ------------- ------------------•--------------------- ---------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------_------------------------ --------------------- --------- DATE-- --------------------------------- ------------------------ Alterations and/or recommendations------------------ ------------------------------ -------------- Ar -------- - - 1 ----- -------------- --------------------------- --------- ------ ------- --- - - -------- / ! __ --------1 �� -L _l�------/� -----------37"'o1(I---1 ----------------------------------------------------------------------------------------------------- --- --------------------------------- -- - -------------------------------------------------------- - ................... -- ---- ............. ---------------- - ---------------- ------------------------------- ----------- .................. -- ----- ----I------------------ - ----------------------- -------- ---- ----I-------------------- FINAL --- ----- X FINAL INSPEC - - Date----------------- --------------------- SAN --.-------- ---SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Sheet 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 7M 1-67 Vanguard Press A €