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l FOR OFFICE USE: S,r 35 -------------------------------- -------- -------------- �. APPLICATION FOR SANITATION PERMIT Permit No, lid_ .............. ---------------- --- --- ------ (Complete-in Duplicate) Date issued ___________________ ------------ - - This Permit Expires 1 Year From Date Issued ---- Application is hereby made to the San Joaquin Local Health District for a permit to copsttrrruct and install the work herein described. This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATION..___/. o p�i� G T�Gr c.ts �i4 y /t7o P.q�-9 ---------------- -------------------- --•/------------------------------ ------------------------------- Owner's Name----____-_se 0<3 S r��F Phone_.?els^s/9 y[ -- - ------------------------------- -------- ------ ---- --------------------------------- ----------------- �/n �a€ el-v p).6e•e G w 1',3 & �19a 4 v C< G4 C7- Address-----------_-----------_:Z--------------------------------------------------------------- 7- Address------------------------••------------------------•--•-------------------------------------- -------I/----------------------------------------- - Contractor's Name----- -------------------------------------------- ------------------ Phone------ ---------•---•-----------_ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ----- Number of bedrooms 3__ Number of baths -------- Lot size _____ ___ ________ -------- -------------_.___. Water Supply: Public system V1 Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R5 Hardpan ❑ Previous Application Made: (If yes,date-.................. ) No ❑ New Construction: Yes X No ❑ FHA/VA: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 240 feet.) C!�-vCRC�T Cr Septic Tank: Distance from nearest well_________________Distance from oundation--------------------Materiai _________________._.__.-__._____._._____ No. of compartments_.__.__X_-__._....__Size-_� .._..�_ '.___Liquid depth------ ' /C-R'° _ _.___Ca acit Disposal Field: Distance from nearest well.................Distance from foundation---1-,45__. Distance to nearest lot line----------------- Number f--__--_-_.___ ® Number of lines________-___v..-... Length of each line__.____ -`_________.width of trench_._.____ '_�''�.__..__-_ -- % - c Imo. Type of filter materlal___?? ____K___.__Depth of filter material___-----____ ___----Total length_-__ `s _____________________ Seepage Pit: Distance fo nearest well----------------------Distance from foundation___________________ Distapce to nearest lot line__________.__... `�► ® Number of pits... .'Y____.__-_Lining mate riaiSize: Diameter._...�a-_.._-.-.-_-Depth--___ Cesspool: Distance from nearest wolf ________________Distance from foundation_*. 1�'.. .1ining material__ _._. G1 ----------- Size: Diameter. ---------_.De th----------------------------------------------- .Liquid Capacity ----- gals. ❑ - - p q P Y - -- - 9 Privy: Distance from nearest well_________________________________ --Distance from nearest building_______._______.._._____.__._._.______.._. ❑ Distance to nearest lot line ---------------------------------------------I-------------------------------- ----•------------ ----------- - . ----- ----------- Remodeling and/or repairing (describe) ---------- --------•-------------------------------------------------------------------•--- ---------------------------- t ---- ------------------------------------ -------------------------------------------------------•----------- ------------------------------------------ --- --- ------------------- - - i l 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. j Q sr-� tet/ 3o Nq-,..�. 0-1/ C c. (Signed) --- --- ---- ---- - (Owner and/or Contractor) By: --------(Title)---------- ------ --- - --...---- - ----- - -... ---- - --------- (Plot --- ---(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY rI APPLICATION ACCEPTED BY- ...ZQ, --------- ---------- --------------------------------------DATE-- 7n_:!�-7--,/-Apy---1--------------------------- REVIEWEDBY-------------------------------------------------------- -- - - -------- ---------------------- ---------------- . ._ DATE--------------------=----------------•-------•-- --------- BUILDING ----. BUILDING PERMIT ISSUED-------- -------- - - ------- - .. DATE--------- ----------------- ------- ------------------------- ---- Alterations and/or recommendations:__c --- --------------------------------------------------- ------------------------- •--•-- --------------------------------- ---------------------------------------- ---------- ------------------------------------ ---------------------------------------------------------------------------------- FINAL INSPECTION B � �?-6 . . . Date- l-- /------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,Colifornia Tracy,California E.H.9 2M 1.67 Vanguard Press - F -