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. . APPLICATION FOR SANITATION PERMIT Permit No. ........ .... .... . .......... ......... (Complete-inlicate Du Duplicate) Date Issued 5`6.._!W ................. .......... .... .-... ...-. .-. This Permit Expires 1 Year From 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. JOB ADDRESS AND ...........k-•-_-_/til-. 0o.Wa.. .._I_ 1 .•-_....Ta .............. le Owner's Name. 1� !L 1 ,r.. vr,eo.......----- _ �a�[a-.l� ... ...... . .........................•------......_.. Phone_ - -_x?_7—,6 Address........ '0ga.!t7 ?.._.._.. - ........................................... CContractor's / - ontractor's Name. 0;<_s,. . r.f. sj f. .. .�/..' ....... .. .......... . ............................... Phone..�`oP.4 -:s�_.f Installation will serve: Residence/% Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: Number of bedrooms Je""'NumbBr of baths...,1.. Lot size ..... .... . .. ........ ..... Water Supply: Public system ❑ Community system ❑ Private3< Depth to W r Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous*Application Made: (If yes,date_. J No ❑ New Construction: Yes�o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi sewgr is available within 200 feet. / Septic Tank: Distance from nearest well__..:...Distance from fou iqn_....-�1O.....Mater•al .__.��-U� f f Ca aci -No. of compartments., j...---,--`-•: --Sizi .,4 .-#JL_ . _L{ uid de th--- �. Disposal Field: Distance from nearest well Distance from foundation___../f2.—�Distance to nearest lot line......e.,r�s1.'� Number of lines.2r.. ................ }Length of-each line__�Q_f-.___-____-__.--Width of trench...aZ�.r)_. .________..__ i Type of filter mate �� ✓Jf epth of filter material_..__._./ __{..Total length_______________. Q.......-.... Seepage Pit: Distance to nearest well......................Distance from foundation...................Distance to nearest lot line................. f; ❑ Number of pits--.-----------------Lininij material-__•_---------------- Size: Diameter-----------------------Depth........................___------ 6 Cesspool: Distance from nearest well................Distance from foundation................. ..Lining material..................................... ❑ Sire: Diameter. .. .... ................Depth...................................................Liquid Capacity............................gals. Privy: Distance from nearest well.................................................Distance from nearest building----------............................. ... Cl Distance to nearest lot line ........ .......................................................... --------------•- ..................... •--.............. Remodeling and/or repairing (describe):----------- ......................................-----•---•----•--------------- •• .........._................. -------------. -------- - -�r��2. �.-._......................................................... � -----------........................---------------------------------------------------------------------------------------------......................................................---------------------•--... •- - - -- ---------------------------------------• --••--••----•-•----••-••---------------------------------------•----- ---------••------------------------------- - . ----------------•----------•--•-•-- -•-- ----...._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat ules and regulations of the San J a in Local HeDistrict. t q\,�J (Signed)...... E...... b.f ..I..J -kci]7 fir_ . lZ>! . .__..._!fes.......... ....... ......�r Contractor) By:................................ ........................ ... .. .................. ;..� - ... ... ......(Title).......... ...._. ... (Plot plan, showing size of lot, location of system in relation wells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . _.. .....-----••---------------------------- ------ - DAT E..t r------------6--------------------- REVIEWEDBY------------------ •------------ ...... ---- ..... --------------------------------------------------------------------- DATE.................. -------------- --------------- ---------- BUILDING PERMIT ISSUED----------------------------------------------- ............—..................--.................. DATE----------- Alterations and/or recommendations:----------------- ----- --------------------------------------------------------------- -----•------------._.................------•--------•-••--•- .......................... ------------ ------------ -- - ---•-•---••---•------•---•---•--••-----••----•------••--•-•----•--...------•-------------------••---•------------ -----------------•--•--•-- FINAL lNSPECTIpN BY:. ---•--------------- Date...... r' � r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfoaelton Avo. 300 West Oak Street 124 Sycamore Street205 West 9rh Street '-1 Stockton,California Lodi California Manteca, California Tracy, California E.H.9 2M 1-67 Vanguard Press