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t-UR OFFICE USE: W17 ------------------------- ----------- -- -------------- -- -------- --------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. - -- --------------- ----I --------- (Complete-in Duplicate) - ------ ----------- -- ----- ------ ............. . This Permit Expires I Year From Date Issued Date Issued 1-1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein cle This application is made in compliance with County,Orclirippc , No. 549. Z(ribecl. �:S CA LON D JOB ADDRESS AND LOCATION ---C------ :17TV- ---------------- -D Owner's Name ------- ------ ------ ----------- -ca ----------- Address----------FT ---- -------------------- -=1-sr ----- t\---------- ........ ... Phone--..-------------------- ----------- ------ BOX-----------vl��3 I _P_0 I Contractor's Name.... FRF-.D------Ao-B'at _.-------------- ---------- -- -- ------- ---I----------------------------- Phone----------------- Installation will serve: Residence Er-'Apartment House .[] Commercial 0 Trailer Court Ej Motel [I Other E] r3Number of living units: --t---- Number of bedroomsNumber of baths Lot size I�CRJEAF Wafer Supply: Public system E] Co �fern [I Private P-15epth to Water Table357ft mmuni y sy! TZAVGravel E] 'Sandy Loam E]. Clay Loam [3 Clay C] Adobe E] Hardpan 0`7 Character of soil to a depth of 3 feet Previous Application Made: (If yes,date_-..___ -- -------- ) No New Construction: Yes E] No 2j--FP_A/VA: Yes El N 1 0 TYPE_OF INSTALLATION.AND-SPECIFICATIONS:m---= (No septic tank or cesspool permiffed if public ubl;c sewer is available within 200 feet.) Septic Tank- Distance from"ndaresf well------------------ Distance from foundation.__---.-.---.-.-___ Material F_X05 Ti r4c.— No. of compartments------------- ---- --------Size------------------- -----------Liquid depth--------- - ----- -- Capacity----------- ------------- Disposal E' Id: I D�stance from nearest well---:�i�...Distance from foundation------ -0-----_Distance to nearest lot line---- r t Number of lines]--------I----------------------Length of each line-- Type o� filter material-_- --___Depth of filter material------ Te---'Width of trench _24�1----- ----------- -----------Total length---------- Seepage Pit:4� Distance to nearest well ---Distance from foundation--------------------Distance to nearest lot li'ne----- ------ El Number of pits---1 -----------Lining material--------------------- Size: Diameter-----------------------Depth-- ------- - - - -------------- Cesspool: Distance from nearest well ----------------Distance from foundation-------- ------ -.Lining material_._---.-------_-----_--_-__------ k ❑ Size: Diameter. .- Depth------- --------------- ---- --- ---- - - --------Liquid Capacity-- ----- ---- ------ Distance from nearest well ------------gals. e Privy: frorn nearest building----------- El Distance' to nearest sf lot line ........ ............ Remodeling and/or repairing (describe):.-----_-- ---------- - -- ----------------------------------------------------------------- ---------------------------------------------------------- -- ----------------------------- -------------------------------------- -------------------------------------------------------------------------------------------------- ---------- ------------- -------------------------------------6--------------------------------------------------------------------r------------------------- ------------------------------ ------------------ ---------------------------- .......................... I I-------------------------------------------------------------------------- ------------------------------------------------------ ------------ ------------ I hereby certify that I have prepared This application and that the work Will be done in accordance with San Joaquin Count' ordinances, State laws an rules anclj�regulaf�ions of the rSan Joaquin Local Health District. (Signed)--- -------------- -- - - ------------------ -------------- ------------- ---------------------------- -- -------------- ----- --- ....(Owner and/or Confi-1070 ------------ -------------------- --------------Z------------------ --- --------------------------- ------------------------(Title)itle)----- ------------- ------ ------- ----- ----- --------- (Plot plan, showing size of lot, location' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_.-.--- REVIEWED BY _ __!0's._{ ._--_____________ - --------------------------------------------- DATE------ ......................... ------------ ---------__ - ------------ ------------------- ------------------------------ ------ DATE----------- BUILDING PERMIT ISSUED-----------------I-------------------------- ------ --------------------- - -------- --- -------1. DATE_ Alterations and/or recommendations:-I-- -------------------- ---------- ----------- ------------------------ ----------------------- ..........---------- -------------------- ------ -- ----------- ------ ---- ---------------- ----- -------------- ------------------------------------ ------- -------------------- -------- ------------------------------------------------------------ ---------- ---- -------------- ------------------------------------- ---------- -------------...... --------------------------------------------------- R ------------------------------- - -------------- .... ..I I -- ------------- -- ----- ---- --- ------------- ------------------ ------------------------------------7------------ ---------------------------- ................ ----------------- ........... .. . ... ------------- ---------------- ---------- ............ ... ........ ----------------- ........ FINAL INSPE --------- Date-L -7----------a. -------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nalettan Ave. 300 West Oak Street' 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy, E.H.9 2M 1-67 Vanguard Press .CaMornia