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' FOR FFICE USE: ..-_ --_ _ --------------------- ----------. APPLICATION FOR-SANITATION PERMIT Permit No. __ l!_...Y..�/ --- i {Complete-in Duplicate} Date Issued ___ -------------- --------- .___...___..._....- �,, .,Tiis Permit Expires 1 Year ;,__From Date Issue 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 ANDLOCATiO�I- /a < ---------------------------------------------------------`------------------------ ` Owner's Name.---------aw/4-�p--//ew--__-� 0-41_/----•-------------- -- -- ------------------ Phone------------------------------------ Address------------�iZAP----- _ /"-......�+ Contractor's Name-------------�oL(A ' ---------- - ----- ------- ----------------------------------------------- Phone----------------------------------- Installation will serve: Residence °Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living.unitfs: Number of bedrooms _*.5- Number of baths.A__ Lot size A?1ri'or----------------------------- __ Water Supply: Public system ❑` Comm uriityjsystem ❑ Private RR"05epth to Water Table tt Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay 0 Adobe??-'Hardpan ❑ Previous Application Made: (If yes,date_-_-----._.,_______ J No Z�- New Construction: Yes gg--i�o ❑- FHA/VA: Yes J4.-. No ❑ TYPE OF INSTALLATION AND SPECIF[CATIONS: f l (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) q - - /" O Septic Tank: Distance from nearest well -___ _..�__Distance from foundation_-��-•-------Materia� 00w5—e--- ---------•- No. of compart ments...A_ ________________;5ize'j�J _-' -Li;quid depth_.. �. - -. Capacity_,1.�4i0�t---- - Disposal Field: Distance from nearest well_/' ? . Distance from foi ndation__4<e .---..Distance to nearest lot line_-_-_____ Number of lines.____-�'�.__. Len th of each line__ o --f -- --- g RIO------------------Width of trench.-A---------------------------- Type of filter material/li �fDepth of filter material--- _ _.--.Total length---v2_StEl-__'------------------- k Seepage Pit: Distance to nearest well------_---------------Distance from foundation__---___-----.._._.Distance to nearest lot line_____-__-.---__ k ❑ Number of pits--- ------------------Lining material-------- !-- Size: Diameter------------------ ---.Depth------------._.------------------ Cesspool: Distance from nearest well ________________Distance from foundation..---------- _.Lining material...........------..___-._.__.__ ❑ 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 ----7?01;_ �------------------------•------------------- ------•--•----------•----------•------------------- - t - - ------------------------- ---------------------------------------------------- ----------------------------------------------- I 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 pules and regulations of the San Joaquin Local Health District. rr , (Signed)------------------ / r (OadJor_Contractor) BY ---- --- -- ---- -� Title - { (Plot plan, showing size of Iot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY ,,-APPLICATION ACCEPTED BY__A ---------- --------------------------- -------------- DATE__.._- REVIEWEDBY------------------------------- ----- ----- ------------------------------------------------------------------- DATE----.-- = ---•-------------- BUILDING PERMIT ISSUED-------- -- ------ DATE Alterations and/or recommendations:------ ---- - ------------------- ---- -------------------------------- ----------------------------------- I __ ------------_-------------------_-------------------_____________ ______________________________________ -----------_-----------_----------------------------_-------_---------------------------_________------------------- t - ------------------------------------------------ - -------- - - --------------------- FINAL INSPECTION BY: 1�.1. . - ----------------- Date------------- '- --.� . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Ladi. California { Manteca, California Tracy,California ♦ 1 r i ' E.W.92M 1-67 Vanguard press t, i