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t-UK vrric t USt: -------------------- ---------------- --------------- -------------- ----------- --------------...____.._........ ................ ... APPLICATION FOR SANITATION PERMIT Permit No. ---------- -- ----- --------------------------- (Complete-in Duplicate) ------ --- This Permit Expires 1 Year From Date Issued Date Issued 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. r JOB ADDRESS AND LOCATION------l-✓ w.� 4 Owner's Name.. �r�� •- Address-- f: ` ' `e Contractor's Name-----� P� ---- ---- - --------••- --------- ----- Phone_ L -� 17 Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _____ Number of bedrooms 3--- Number of baths---I---- Lot size ____. 1E7E-- •------ �f ---------------- Water Supply: Public system E] Community system F] Private V?'Depth to Water Table 4—P,- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sa dy Loam Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: {If yes,date--------------- ] No;?r New Construction: Yes J?�`No ❑ FHA/VA: Yes ❑ No 1'7 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available--within 200 feet.) Septic Tank: Distance from nearest well_.A0P__----Distance from'foundation--- d_ -------Material __ ----_------------------------- No, of compartments_.___.__-_ ____..__.Size-b}�__X_ ------Liquid depth_.9L_"_ --_... ....... Capacity..42i40 -� Disposal Field. Distance from nearest well.ar�---------Distance from•foundation___:1.-5._l__.._.Distance to nearest lot line__---0 Number of lines__.____ l " .�.------------- Length of each line-- -- P --��------- Width of trench._--, -/ ---------------------- Type of filteir material__ - Depth of filter,material___C ._ Total length -___.- - _ g - -------- Seepage Pit: Distance to nearest well .__.15-e--_------Distance from foundation-_--r3 _ .__.Distance to nearest lot line... .__. Number of pits--- ----,�--------Lining material-- 7 :_--.-- Size: Diameter_ - - ------Depth---1 a-7--------------------- Cesspool• Distance from nearest well ----------------Distance from foundation.............---- _ Lining material--------------------------- ❑ Size: Diameter- - ------------ --- - --------Depth.------------c,•-------------------- -------------Liquid Capacity- --------------- ----------gals. Privy: Distance from nearest welt.___...._- _____Distance from nearest building Distance to nearest lot line---- --- ------------------ ---------- - Remodeling and/or repairing (describe):-------- --- - -------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------•---------------------------------------- ---------------------------------------- -------------- --------------- 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).�Y�-- - -- ---- -------- J .....-----(Owner and/or Contractor) - / -- - -- --- - --- --------•------------------- (Tit _ of plan, showing size of'lot;location of system in relafion to wells, buildings, etc., can bele) placed o everse side). FOR DEPARTMENT USE ONLY JJ APPLICATION ACCEPTED BY___`_;_f�O--------- --------- DATE_----.1.47__`- 7_s..1FT REVIEWEDBY------------------------------------------------------------------------ -- -----• DATE------ -- -- -- - ----- ----------------- •- BUILDING PERMIT ISSUED DATE. Alterations and/or recommendations:___ .._rf.T_...__ E �F� fC In. i=__D,. ---------- --------- - R ---> FV.R _. ._RA/A4----1NSP-�.--(W-� ------------- ------ ------ FINAL INSPECTIO 14 Date.. SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press