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EOR OFFICE USE: - - - 1 1 - r ------------- ---------------------- -----------;,�-- -------------------------------z - --------------------.__.----------- APPLICATION FOR SANITATION PERMIT Permit No. 0-(-- ------- - --:------------ ------------ ........ (Complete-in Duplicate) ------------ --- ..--- This Permit Ex '''resl"Year From Date Issued Date Issued 5._- _.- $- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION----_z_1_.t/_7S....5---------5 ?STO ------ TSCA_LOri Owner's Name-------- �� - -1� Sn" Phone -----"----•--- Address ! eQFE��----------Rb------------------MOD f-.G7F0 _ Contractor's'Name------691-VIV-�'ti_l-•--------•------------- -' ------------- Phone------ --------•-•----------------- Installation will serve: Residence i 901T T El: Apartment House ❑ Commercial E] Trailer Court ❑ Motel ] Other f-} ®-WIEIErMT d-GRADE- S AIV Number of living units: __ ----- Number of bedrooms -------- Number of baths-------- Lot size __ �RA _-_- _ Water Supply: Public system ❑ community system E] Private �epth to Water Table _ ft Character of soil to a depth of 3 feet t• Sand Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe ElHardpan ❑ Previous Application Made: llf yes,date----------------_- I Noe�New Construction: YesNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) -,xte._ . . - _- Septic Ta Distance from nearest well_ .�_ Distance from foundation - Q. MaurJ al eR-Erb No. of compartments.......Z_—----------Size3X_'7__k57_ ___Liquid depth-----'f 1. �. ---Capacity_•-- I Disposal 'eld: Distance from nearest w�ll.. ------Distance from foundation------------------__Distance to nearest lot line----�� Number of lines-i---------------------------_ -Length of each line.- ---------------------------Width of trench.-----._.��z --_-'- Type of filter material---- of filter material al__.-.----- -' -------- length-'-'- ----�Q---------------------- Seepage --s-- --- ----"=-=--- Seepage - �. . Pit: Distance to nearest well from foundation--------------------Distance to nearest lot line-_..___--.._--_.- } ❑ Number of pits--- '----------------Lining material------ Size: Diameter------ --------------- Depth------- -'-'- ---------"-----• �{ Cesspool: Distance from nearest well ------------- __Distance from foundation _ . .._. -- ..Lining material-_._-------------------- s ❑ Size: Diameter- - -- Depth-'-- - �I - Liquid Capacity ----------- Privy- _ gals. - u ---- - Distance from nearest well __--,-. - - "" -----------'---'-'-- Distance from nearest building--.-'--------'------'-_---,- i ❑ Distance to nearest lot line-------' Remodeling and/or repairing (describe):--------..FQ_[ _._,_-S�IAI<( 11 ... � Tt©_ ____._!4T]~ 1VpAf ` --------------------------- ' ------ i ---------------------- -- ----------------------- ------------ --- -- - -------- --- ------------------ 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 rules and;regulations of the San Joaquin Local Health District. (Signed).------ ..... -'------'-' -------------------- - -------- ---------- --------------(Owner and/or Contractor) Plot- lan, showin size-of-lot,Tlocation-�of-system-in-relation to wells, buildings,=etc.; can{bele'laced-on-revers B _ ( p.`_'" g� . -- P e-side). } FOR D MENT USE ONLY APPLICATION ACCEPTED BY------. �_ ,_Q --------------------- -_ ------------------------------------ DATE----'- VIEWED BY. ' {---- ------------- DATE__ BUILDING PERMIT ISSUED------- -- ------------- ------------ ---------- ------------------------------------------ ----- DATE. Alterations and/or recommendations:_............J.IVSTA 4n.��o_._,-- 5 $' � J mss"---------------- ------------------------- t ------------'-'- ----'----'- ---------- ------------- -------------------------------------------- -------•------------------- __ .- -._-.-- ___________________-----------_ r' / FINAL INSPECTIO -- .. - ' Date--------------- ._'._------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �f 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 3 Stockton,California Lodi. California Manteca, California Tracy,California k E.H.9 2M 1-67 Vanguard press