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n-----I VM1 V1 1 It.L IJJL: --------- - ----- - r •----�J-----f"� ------ ------- ------------ --- -- - APPLICATION FOR SANITATION PERMIT Permit No. �� - -------------- ------ ----- ------ orauprk t ) d Date Issued ------------ --- This Permit Expireses t 'Year Date Issue , t5c'a1'+Health District for a permit to construct and install the work herein destr{iced. Application is hereby made to the San Joaquin, This application is made in compliance with 09drity Ordinance No. 549. JOB ADDRESS AND O ION __ �rvr� _uCG ___( �-°2 - � - - Owner's Name--�-`'�--'- ---1--•/1 -- ------------------------------- -----•------- ------------------------ -------------------- ---. Phone.(6_06_--�-7 i Address-01-2.61-2 .. .. •••-----•---------------- Contractor's Name_ / _:• �e.�/ =moi --•----------- --••--- -- •------ ------ Installation will serve: Residence r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __r!----- Number of bedrooms __ _ Number of baths -- t__ Lot size . .�______.________________________ Water Supply: Public system ❑ Community system (] Private N Depth to Wafer Table &_ ft FCharacter of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam W- Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-_----------------- ) No ® New Construction: Yes ❑ No [k FHA/VA: Yes [] No a F TYPE OF INSTALLATION AND SPECIFICATIONS: �f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weII:J_4------Distance from foundation---/Qi........Material---- r No. of compartments_____ +->! �}_________________ l --------__--.-.Size._--- --Q_�--- ---------- Liquid depth.__ E_s :.�.`-. --------Capacity_.p�------------- --------- Ell � __-- Disposal Field: Distance from nearest wellv.0__.....Distance from foundation---1.Q__._.......Distance to nearest lot line--- --- ___._ { ® Number of lines.__-______--- _.. -----------Length of each line__. _'_____________Width of trench____s�-`�_-______.___.._-._._- Type of filter material--- _____Depth of filter material_.__/9':�---------Total length------ _'---------_--------------- Seepage Pit: Distance to nearest well----------------------- from foundation--------------------Distance to nearest lot line---------------- ❑ Number of pits--- ------------------Linirig material---------------._----- Size: Diameter------------------ Dep ti{ ..' ------------------ k r :' 1 Cesspool: Distance from nearest well ____.__ .__ __Distance from foundation ............ ..Lining material �` __________.______. �l ❑ Size: Diameter -----.Depth-------------------------------------- -------------Liquid Capacity-------- r-------------•-gals. Privy: Distance from nearest well------------- ..---------------------------------Distance from nearest building_-----_.-___-_.____________-__.-______._. ❑ nearest lot line--------------------------- --------------------------------------•------------------------------------------------------------------------ . r - �_ .. # Remodeling and/or repairing Idescribe}=-- / •- �--- -- --- -- �rrr.?_ - --- ---•--• -------- ---- ----------- ------------------------------- i t --'------------ -----------------------------------—------------------------------•-------------------------------------------------------------------------------------------------------- --------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Caua ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. fl /� X -,/?- G/ G ----- - ---------- --------------- ---•--------------- { caner and/or Contractor) (Signed). - sr -_---------------- -----------------------------------------{rifle)---I '--------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y;- FOR DEPARTMENT USE ONLY V" ----------------------------------- ----------- DATE--------2-/ 8-3 FAPPLICATION ACCEPTED ;.-_-_._-------------------- - REVIEWED BY-------------------6--_/ -- - - i BUILDINGPERMIT ISSUE -------=---------- ----------------------------•---------- ------ DATE------------------------------------ -------- Alterations and/or recommendations....................... - ----- ----- ------------------------------------------- ------ ------------------------------------------------------------------------•-------- •------------•-------------- - - ------- FINAL INSPECTI B2. -. ----*. UIN rL Date /9-,J LOCAL HEALTH DISTRICT 141 1601 F.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi, California Manteca,California Tracy, California k � E.H.9 2M 1-67 Vanguard Press