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FOR OFFICE USE: - ' � �3s- IM_ ____ __ ------------------------------------ _____________ ___ ______________ APPLICATION FOR SANITATION PERMIT Permit No. __._..------ l� (Complete.in Duplicate IMThis Permit Expires i 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 w rk herein escr]bed. This application is made in compliance with County Ordinance No. S49. _ �� "J 1 s�a- zo JOB ADDRESS AND LOCATION-____x''0440_._ _A� :r_ Q ,�-(� ?--ice-_-9/7 A�_, 9 4 Il Owner's Name________ �R--17-7e---5----•-�'L--�-k-(,��"=�>��--------- ----- ----- ------------------------------ - - ----- Phone------------------------------------ Address ---------------------- - ------------- Address-------------��_�••----�-F-----�-�Z/f�---��..---�---►.�---��C�.��Y--------------------• - -- ----------------------------------------- Contractor's Name---------- ••=- _4PO?4e - ------------- ------- -- -----------------------•------------------ Phone------------- ----------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z-__ Number of bedrooms-. Number of baths/IF Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 495-61 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ l7Previous Application Made: {If yes,date-...-_-_ _.._ l No New Construction: Yes �lo ❑ FHA/VA: Yes R4—No E]I�TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic.tank_or cesspool-permitted,if.public sewer�is-avail able within 20Q feet) _ Septic Tank: Distance from nearest well... ___Distance' from fount ati�__-��__ --_M t�al�/We- e_ No. of compartments----�-_-- -.Size_ __ _ Liquid depth ---- -..._.Cam :.ty_�f y�� Disposal Field: Distance from nearest well-,c!!�V__,_Distance from faundation__,.10_W____......Distance to nearest lot----------- - ------- Len line_______.. Number of lines__ _. _ - - Length of each line_ ----- - �-------Width of trench- ,�----------------------- ---- ' Type of filter material/ '1-.i.-e0_e_ _Depth of filter material___ __Total length---v2 G;_f____________________ , 'Seepage Pit: Distance to nearest well-...................-Distance from foundation---.._._.---------- Distance to nearest lot line--________---._-. N I ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Deptn_-------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation_................ Lining material-- --_---------------------------- ._. ..,� E ❑ Size: Diameter- -- ------ ----- ------=------- Depth----- ---------------------- ---- -----I----- ----Liquid.Capacity----------------------------gals. Privy: Distance from nearest well_______________________________ ______________Distance from nearest building------______.______________.___-........ E El Distance to nearest lot line -- ----- ----------------------------------------------------------- ------------- �p iRemodeGng and/or lrepairing (describe) - ,(p_�----- --------•------------------ ----------- ----------•------------------------- ---------------------------------------------------------------------------------------------------------------•-•---•---------------------------••---------------------------------- I 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------------------------ Q G' - � ( Contractor) I r I� BY: - -(Title)------- {PlotJplan,showing'size-of'lot, location of system'i ation-to wells,-buildings,etc.,, can be'placed o erse - ,i i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L��,// "" - A f ,/ DATE-- REVIEWED BY ------------ ------ -- QATE BUILDING PERMIT ISSUED-------- --------- -------------------------------------------- ---------------- ---- ----------- DATE - 'Alterations and/or recommendations------------------------- -- ----- ............._ _.- ------------------- - --- _--- ---------- - - 4 --------- --- ------ - ---------- ---------------------------------- -- 4__----------------------------------____---------.------------------------._-.- -.-_ .-_- r FINAL INSPECTION BY:�__ " -------------------- Date.- "------ /__---~- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Narollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Collfornia'� Lodi, California Manteca,California Tracy,California E E.H.9 2M 1-67 Vanguard Press I e