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OR-OFFICE,USE:... II APPLICATION FOR SANITATION PER ---- -------- EMIT Pe'rtx►it No.:.r�l - -----------------------------=---------------------- ---- (Complete 4n Duplicate) date Issued _ __.f F�17 --------------------------------------- This Permit Expires_1Y_e_a_r From Date Issued Application is hereby madel�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. 5.49. -4 "v'w L� 7L 1-7 ore JOS ADDRESS-AND LOCATION-- �" + --- .--- e ,� ---------------- 7-: ---- Owner's Np'ne-------`VGI �1 ' ¢�0 5------------------ ----•----------------------------------------------------------- Phone 5 ($ ,� j 4?1_e----------------------------_----------------------- Address!_______. .�15 ,� ---- ` 3 Contractor's Name---------1��►.ro �f i :-------------------------------- Phone .3 In;tallation will serve:' Residence [)flApartment House' ❑ Commercial [:1Trailer Court ❑ Motel ElOther ❑ Number of livingunits: -- ----- Number of bedrooms _ --_ Number of baths _I---- Lot size __.________________________ _________________•__.______-_ ; Water Supply: Public system ❑ 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 ® Hardpan ❑ Previous Application Madel, (If yes,date----------- ) No ❑ New Construction: Yes W No ❑ FHA/VA: Yes ❑ No ❑ 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______________ Distance fr•on foundation,-.. _._ Material _____ -------------------- h1 0 r� [] No. of 'compartments--------- Liquid depth----.---'---------.-----Capacity-- --- ------------ Disposal Field: Distance from nearest well-----------------Distance from foundation------------------Distance to nearest lot li e-------.r_______ ❑ NumbecMof knes------------Z - ------------ Seepage -- ___-Length of�each line______�_42_______________Width of trench._.._ --_ _ 7-____.. rs a., e Pit: Distance tloenea est Iwlell----------------------D span effrotmrfoundaal__________-_----___--Total length--------------------•---------------_----- Seep g tion--------------------Distance to nearest lot line-------.______.__ ❑ Number`` of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth--------------------------------- Cesspool: Distance from nearest well___._._:------- Distance from foundation--------------------Lining material___-------..-_..____.__.___________-- ❑ Size: Di'ameter____... . -. Depth _. ______ ____________Liquid Capacity _____._____ gals. --.�`d� �. M;r�.,� Privy: Distance from nearest well____. ..___ ________ ____ ___.__.__..D1stance from nearest building___ .._____-_ ______ _ ._..--..- ❑ II �. - _ r w�--r--+ •---- - _______________________ Distance to nearest lot line.--.. =.::---;:;-;- - �- :._;---,-------w--------------------------------------- Remodelingand/or repairing (describe):-------------------------=---------------------------------------------------------------------- --------------------- -----------•--•------------------- ' -----------------------•---------------------1M------------------------------------------------------------------------------------- --------------------------------- ------------ - ---=-----------=�---------------------1----------------------------------------------------------•-------------------------------------------------------------------------•------•-------------- ------------- --- mow. i I. hereby certify that Il 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) ------------ -' - ----------------------------- B " ---------- --------- (Owner and/or Contractor) ---- ------------------------------------------------- F — p V �Y By:----- ------------------ •�:,�=;:-------- (Title]_:1' = -------- - "�(Plot—plan—, howing size of tof,.locition of system in r lotion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY k 4 — APPLICATION ACCEPTED BY. ----- _ - -------•----------------------- ----------------------------------- ---- DATE------ ---------------------------------- ED --------------------------------- REVIEWED..BY. J1 --------------------------------- ------------------------------------------.- DATE--------- -------------------------------------------- V i -+ BUILDING PERMIT ISSUED------------------ --------------------------------------------------------------------------------- DA•TE------------------------------------•------------------------ Alterations and/or recommendations:----------------- ------------------ --------------------------------------------------- •----==-----= -------- ---------------------- ------ ------------------•---- ----------------------------------- -----•------------------------------------------ -----------------------------------•-------------------------------•--•- - ---------- --- - I------ ------------- --------------------------------- ----------------------------------------------------------------------------------- - .II ----------- I ------------------------- -------------------------------------------------------------•--- I ,,.. ------------------- p------- -----------------------•---- ------ ---- --- ------------ ------- FINAL INSPECTION BY . /.. Date----------- -1--1------4--- 7- - - ---- - --------------------------------- i AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California f x