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/11 W'40&R OFFICE USE: 2; 0 01,nM Permit No. -- -------------- --- .----- - ------ APPLICATION FOR SANITATION PERMIT - - ---------- ------------ ------ (complete-in Duplicate) Date Issued ----------- This Permit Expires I Year From Date Issued ---- -- --- I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAATnTION------r`;? -------- 1p�� ---------0 4 VD-------------•---------.... G i Owner's Name. Y'-- _rl�t .. /C- j I= - -- Phone Aa3- 3��+ Address. r7._0. �Sh _ _.__. �if�'L. _/ ---------&K:Z,------•------ .-...--•-- ``�� Contractor's Name------ -------P_�-R�__�.,�__i�.- -----�---.S.��,�.- - -INC------------------------------------ Phone-ef(*MP/......... Installation -------------------- - --------- Installation will serve: Residence 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _` Number of living units: __�-__ Number of bedrooms �_ Number of baths-1----- Lot sae -4?d ----- ----------- ---- Water Supply: Public system '] Community system ❑ Private ❑ Depth to Water Table7d _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel F1Sandy Loam L:1Clay Loam ❑ Clay E] Adobe X Hardpan ❑ Previous Application Made: (If yes,date-------.----------- ) No'�1 New Construction: Yes ❑ No � FHA/VA: Yes El No� TYPE OF INSTALLATION AND SPECIFICATIONS: /� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q ` Septic-Tank: Distance from nearest well----------------- Material ------------------------------ ------- F' ___.._Dis}ante from foundation__________ __ __ _ _ Capacity-.. ❑A5�'r No. of compartments------- -- Size Liquid depth p Y ��__.___..Distance to nearest lot line.__.__--_--•. Disposal Field: Distance from neare t well_/ t'U _Dastance from foundation_. __.._ rt Number of lines.(_Q-______ ---_____ Length of each line-_, f�__..__ _ec----- Width of trench_.fir ---.--------------------- Type of filter material__... __._ Depth of filter material----ai__ _._-_.__ Total length___ -----------------•------ J^ Seepage Pit: Distance to nearest well__/JDAU -----Distance om undation__ --._..Distance to nearest lot lin-Zo-_-__.- Number of pits.-CI_ __.____...Lining material.- ---- Size: Diameter.. sl'._ - --Depth__ -s-------------------- Cesspool: Distance from nearest well ----------------Distance from foundation----------------- - Lining material....--------------------------- al-- ❑ Size: Diameter- -- -------------- -------- ---- --Depth----- ---- --------------------- - -- ----------Liquid Capacity_-- -----g Privy: Distance from nearest well----------------------------------------------- Distance from nearest building_____-___.__._____.___.___.___.._.__-. 06Z Distance to nearest lot line ------------------------ - ----------------- ------------------------------ 11 k , a�! __. ------------- -------------------- ------------ Remodeling and/or repairing {describe]----------- ------------- ------------ -------------------------------------- - --------------------------------------------------------------- ------------------------- - I hereby certify that I have pre pared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and es nd regulations the San Joaquin ocal Health District. I Owner and/or Contractor) (SS� ned _ ----- ---------------- ------------ igned)------ ---- -----------------(Title)- = ----- [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bt/,.4V— ------------ DATE__X�_--=/4-"`-l®1--------------------------- REVIEWED BY------------------------- - -------------- --- ------ - ------------------- --------------- - DATE-------- -------------------- ------------------------------ BUILDING PERMIT ISSUED.---------- ---- ------------------- ------ ------- -- - ------------- - DATE Alterations and/or recommendations. -�.ol -_- --..-- - Q ------------ ---------- ------------------------ ----------- -- . . .. ........ -- ------------------- / FINAL INSPECTION Bj? - -------------------- Date_.9�- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasolton 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