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FOR OFFICE USE: 1' ` APPLICATION FOR SANITATION PERMIT Permit No. .__.,! . ��d-•1 r --------------------------------------------------- (Complete in Duplicate)- � P p. ) Date Issued ___C'_7_AS_ �This Permit Expires t 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. (403-260- Z -JOB ADDRESS AND LOCATION / `f x 7..---�Ta��°-n------- -- �-� 7` n Owners Name 1"'4fJ�4 _ �I''D-�?�� r -------------------------- Phone y--. 0 tAddress-----------_--_---_---------__ _/vve_---------•-- •-----------------------------------------------------------------------------------------------••---- ----------------------------- Contractor's Name------------------------aV_A, _-!94--------•------------•-------------------------------------------------------------------------- Phone--------•-------------------------- I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms ----/_ Number o baths'__--- Lot siz ------------------------------------------ Water Supply: Public system F1Community system E] Pr epth to Water Tab1M - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San �y loam ❑ Clay Loam E] Clay E] Adobe T Hardpan Previous Application Made: .(If yes,date._--_--------------) No New Construction: Yes o ❑ FHA/VA: Yes ❑ . No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'Permitted if public sewer is available within 200 feet.) p I �� /1C�lc�d Septic Tan •. Distance from 'nearest well__�..___Distance from f undati n-_._.- _--_- _ Ma ri L________________________________________________ "� p� Nb. of compartments..-_.._-..2lf--_.Size---�_X-_- 9 _ _Liquid dept/------- y _._.---Capacity-----0/71—" Ifrom . d_--__-.Distance to nearest lot line_________.. Disposal field: Numaberof f nesnearest well___ - LDistance e gth offrom each I ne foundation-__ Width of trench---._--..__2- - - .- T e of filter material _-_. . . 9' � 2- Type � ___ iyDepth of filter material___,-__��__..Total length____.____. '_ __ __—:_____�_____ _ " Seepage Pit: Distance to nearest well----------------------Distance from foundation------.------_-----Distance to nearest lot line----------------- El Number-of pits----------------------Lining material------------------ ----Size: Diameter-------------- ------ Depth-------------- ------------------ 1-f- ----------------- 1-f. Cesspool; Distance from nearest well-----------------Distance from foundation.-------------------Lining material-.-___.._.-_.___-_____._-__--_--. Size: Diameter,---------------- -----------•---__--De Depth ------------------- . ---_-- Liquid Capacity-.. gals. Privy; Distance from nearest well.-_--._---------- ---�---_-------_---------...Distance from nearest building-----.--------------.___---____.-___._..- ❑ Distance to nearest lot line---------------------------- --- ` and/or . -- r -._... emoe mg (de"S Libe):- ----- ------------ ----------------------------------------------------------------------- ... - -- --- --------- , -� "' - ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ --- - --------------------------------------- ---------------------------------(Owner and/or Contractor) By-------------------------------------------'-----------------------------------------------------------------------------------------(Title)------------------------------------------------------..-------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- . ---------- :6- ~L�'------------------------------------- DATE--- ---------d------ ...... f REVIEWED BY-------------------------------- ----- ------ DATE------------- -- --------------------- ---------- ------- - -- • -- - - -------- --------------------------- ---- BUILDING PERMIT ISSUED---------------------------------- -------------------------------------- ------------- DATE----- --- --------------------- Ft Alterations and/or recommendations:------ ---------- ---- ----•--- ------ -------------------- ------ �` -----------•-------------- ------------------------ -----. ------------- - ---.r--- v� � - �~f v.C -�� 1r.ra—i C�i�[� 'L.i.�t'--�.� q� C C -------------•-----:!e'e ---------------------------h----------------------------------•--•------------ -----��---------------------------------------- --------------------- ------_–•--------------- ----------- -- l ---- - - d -- - i FINAL INSPECTION BY: - Date....... ----- ------------------------- SAN J.I '"OAQUIN LOC HEALTH DISTRICT .- f 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street { � Stockton,California r Lodi, California Manteca,California Tracy,California I F.P.0 C. r