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FOR OFFICE USE: --a.. -G ---------- APPLICATION FOR SANITATION PERMIT Permit No. --- -------------------------------- ---- ---------- (Complete-In Duplicate) Date Issued /,c;L-- `_ - -----------------------..---------------._-------___._._ 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. f JOB ADDRESS AND LOCATION----- h /?--fps------------ ----------------------- ------------------------•----------- Owner's Name---------aww'z----•-•- AV2------------------------------- ------------------- Phone--------------------------- Address............. Qx ------------- J ------- ----------------------•---••----------------------------------------------------------------------------------------•---- Contractor's Name------ - Phone Installation will serve: Residence Apartment House ❑ 'Commercial ❑ Trailer Court ❑Or Motel ❑ O+her ❑ Number of living units: -,___ !Number of bedrooms _Oz'Number of baths-/... Lot size f---Q�`"�=_'___ -------------------- Water Supply: Public system ❑ Community system El Private �epth to Water TableVV_ _`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--------:........-- 1 No V�Iew 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.) M Se,ptic Ta : Distance from nearest well-----------------Distance from foundation--------------------Material -----------------.------------------------------ No. of compartments- -- - - --Size---------------- --- -•----=---Liquid depth-..---._ ---- Capacity Disposal Field: Distance from nearest well.-.-........ Distance from foundation--------------------Distance to nearest lot line--------------. XXjf i�dy Number of lines----------------------------------Length of each line_.-------------------.--------Width of trench.-------.-------------------------- `0 Type of filter material------_-----------------Depth of filter material----------------------Total length-.-- .------------_-_------------ Q f i ' r -- Seepage Pit: Distance to nearest well--/�.�-----.Distance fr 30 to nearest lot loe-- ------ ----- Number of pits--1.___--__.-_-.-.Lining material-- e�''Size: Diameter-Ag ow Depth,0?4�7-------------------- Cesspool: Distance from nearest well ___-_-__-___--Distance from foundation._ ------------- -Lining material- -- ❑ Size: Diameter- -- --------- ----- - --- ------ --Depth----------------------------------------------------Liquid~Capacity-------------- -------------gals, Privy: Distance from nearest well-------------------------_-------- -------------Distance from nearest build ing-_-.`_'_------.---------------------------- ❑ Di ' stance to nearest lot line ------- ---------- ------/-�----------- -------------------- ----------------------------------------------------------------- ---- Remodeling and/or repairing (describe):-------------- ------f'�'f" 6 =�t ��- ; , ---------------------------------- -- I ------------------------------------------- ------------------•-•---------------------------------" ..s - ------------- --------------------------------------------------------------- ---------------------------------------------------_------------------------------------------- ------------------------- ----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) .. r Contractor a By--------------------------------------------------------- -------------- --------- -------- (Plot plan, showing size of lot, location of system i r ation to wells, buildings, etc., can be placed on reverse'side). O DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY-------- ------------ DATE---.- = `-------------------------------- REVIEWEDBY. - ------------------------------ - ------- ------- ----------- ---- ------- --------------------------------------- DATE------=.. ....r`......--- --------------------------------- BUILDINGPERMIT ISSUED-------- - ------------------- ------ . --------- -------------------------------- ---------- DA•TE-------- '------ #-------------- ------------------------- Alterations and/or recommendations------------- --------- --- -------------------------------------------•- ------------------- ..- --- -------•---• ------•---------- - ----------•--------• ------------------------------------------------------------------------------------------------------------ ------------�} h - .6i- - ------------- -- ---- ---- ------------- -------- ---- ---- FINAL INSPECTION BY:----- . --------------------- l Date----------- f'�— �f`�fj 1--------------------------------------- N 2AQUIN LOCAL HEALTH DISTRICT " • T 1601 E.Hass€ion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California YLodi. California Manteca,California Tracy,California - E.H.9 2M 1.67 Vanguard Press s