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FOR OFFICE USE: -- ------------------- ------- ------- -------- APPLICATION FOR SANITATION PERMIT Permit No. ___1Q- =--•- --------------------------------------------------------- -------------------- - - __.___-_..-------- (Complete-in Duplicate) Date Issued ---k'l�'_ This Permit Expires 1 Year From Date Issue Application is herebymade 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 AND LOCATION----- -- U-�-�-- ------ ------------ -------------- ----� ---------- - ` L /v!.E Lc}-I rt - ---- _ : - � ---- _ >,� ��-----------------••- -;---- : �P one----=---- Owner s Name--------- Y �, � � � t Address h-0 `-�- H:��7:---'------------ - � -------- Phone..-'- -=-----••-------••---------- Contractor's Name----- - - -- ------- --- ------- - - --------- ------- - ---- -------- Installation will serve: Residence'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ____ Number of bedrooms ____._ Number of baths- . _ Lot size ___ ��- -��---- - - - Number of living units: _� Water Supply: Public system ❑ Community system ❑ Private 2j-'6_epfh`to Water Table fXi-ft Character of soil to a depth of 3 feet' Sand Gravel ❑ Sandy Lm❑ Clay Loam ❑ Clay ❑ obe ❑ Hardpan ❑ Previous Application Made: ,(If yes,date_------------ ----- ) No New/Construction: Yes ❑ No FHA/VA: Yes ❑ No�� TYPE OF INSTALLATION AND SPECIFICATIONS: `. .----( p « . n 200--feet.)� Tank: Distance-from nearest well___....._.__._ _Distance from found .-.Material ------------------------------------------------ No septic tank- within Septic foundation-. n!G- No. of compartments- ---.-- � �-�--/--Size-------------=---- ------------Liquid depth------ -- ------- -- ----Capacity----------------------- so -•----------�---- � �___ __-_.Distance to nearest lot line.--5- Disposal ine.-- -...___.. Disposal Field: Distance from e rest wel -Distance from foundation_._/ - ---..Len th of each line-- -- 7Q--- Width of french------3Z_---------/------- � ]�• Number of lines ___--.___. 9 ri.._ - --------------- � �A D� Type of facer materiai____ O_C --Depth of filter material_. ___.._-------Total length______------------ --------------- -- Q E Seepage Pit: Distance to nearest a 1':7_" '` Y'Distance from foundation___.__________--- isty e to nearest lot line________________ Number of pits.._ ._.------------- Lining material--------- ------ Size:,Diameter- Depth_._.- v ❑ 1 Cesspool: Distance from nearest.-well-"`_ ``. ____Distance from foundation----------------- _.Lining material..................._____________-__. ❑ 4 De th------------------------------ --------- ----------Liquid Capacity gals. Size: Diameter- -- -___-- - -- -------- - •- p 4 ? Privy: Distance from nearest well---------------------------------------------- Distance from nearest:building___ _-___-_._.__.-------- •------- - -- r _�- ---------------- Distance ; Distance to nearest"lot IineF'_.__._"":'---------------�--------- --•------- � 4 • I . -______________-.-._-______________________._._. Remodeling and/or repairing (describe}-------------------------------- �-- ----- --------------------- ________________________. _-____.________ i -------•-------------------- --------------- ----------------------------------- I -----•-----••-----••--------------------- F _-. - c----•- .-.- - -----•------------------------------- IF ---...---•-- --•--------------------------•------------•---------------------------------1F -•---------- ------ •-------- ------�- 1 - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rule and regulations of the San Joaquin Local Health District. t ° -----------------_.._.._._..___(Owner and/or Contractor) (Signed)_ yr - -- _�-:�-----�-- 7_,__R_0 -�;;;(Ti+le)_ �� -- Piot Ian, showin size of lot, location of - -__ ____________ -( P g s stem in relation +a wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ._. ._____. ------------ APPLICATION ACCEPTED BY ._._________-- DATE------ REVIEWEDBY------------------- DATE. ................. ....... -------------- BUILDING PERMIT ISSUED-------- -- - ------------------------------------------------ DATE - -- --------------- Altera+ions and/or recommendations:_-____________________________________ -' -- ----- - -- ---- ----------•----------------- I ; i � - --- -------------_---------- ------------------ ----------------------------..... - -- - ------------ i -- - ------------- -- -- ---------------- ------------ -------- ----------- -------------------------- -------- ------77 ------ FINAL INSPECT1fl+W-BX ___ � - - Date - ~ ------------------------------- --•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lodi, California Manteca, California Tracy,California 1? E.H.9 2M 1.67 Vanguard Press