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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- (Complete-in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr ct and.install the work herein described. l This application is made in compliance with County Ordinance No. 549. JOB ADDRES ND LOCATION%_._ _Y., ` _17 ___________ --- ---------- ��, f _ _ Owner's Name_____U ----- . ®/ Phone ' - ---------- . --- Address---------1 -� f - Contractor's Name------- ice= d"^. i _441A.101-10i- -------------------------- Phone....-- ------•------------------_ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: _"' _ Number of bedrooms _ ._ Number of.baths �__- Lot size .__. ................ ,t Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft t Character of soil.to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan �� d Previous Application Made: (If yes,date_------------ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ - a r TYPE OF, INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Xnk: Distance from nearest well__--o5iO_ --Distance from foundation----,V/____.Materia! _________________ __. No. of compartments_.._�:-------...._.Size_3_.X__j._7'4.77 Liquid depth ...... Capaci#y��----. .-.- Disposa leld. Distance from nearest well-- -- - - -- - -Distance from foundation....................Distance to nearest lot line__--_ Number of lines ----------------------------------Length of each lire-------------------------------Width of trench.-._--.-..---.---------.--_------__ Type of filter material-------------------------Depth of filter material----------------------- length-.-._-._..-----.-..----_-------._._-.___. r 41 ` \�i, Seepage it: Distance to nearest well_._��-_._-___Distance from foundation____.�.o........ istance to nearest lot line__._✓_r__.____.._ �{\ f� Niumber of plts.__r _.__._____Lining material__'':5-/7_t. Size: Diameter-___ "_...__.Depth_?? `S-----------.---------- Cesspool: fDistance from nearest well ................Distance from foundation............ -.Lining material--.-..._-__---..--__.-_--_____-_._-. [) Size: Diameter- -- ------------- Depth s----- -- ---------- - - - ----------------Liquid Capacity- ---------- -------------gals. Privy: Distance from nearest well---.__---_-_-.....i-_________________t----------Distance from nearest building...........-_------.----------- ❑ Distance to nearest lot line _._-r_--- E Remodeling and/or repa�ring (describe):------ { /'C-s t om' -------------------------------- -------------------------- -. P 1 1 :. t # 4 I hereb c 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County { ordinances, +a+e ws, and rules egula#ions'ofFthe-San•Joaquin:Loca{-HealfhTDistrict. s ,� r t a ,,. , (Signed).- - - ---------- - ---------- -- ----------- ------- - _--------- ----------------- •-------- ----�- -'----- -- ----. and/or Contractor) By - --- ------ .-- --- . - ---- ----------- = — '------ ----------------------Title) - (Plot plan, showing six; of lot, location o system in q r ation to welllibuildings, etc., can be placed on reverse side).i i t ..sir - t ! 42 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY j 1 F REVIEWEDBY----------- I------- -----------------------------------------' ---------- - -- -------- ------ --- - ------�'=------ DATE-------------------------------------�----------------- BUILDINGPERMIT ISSUED.------- -- - ------------ ----------------------------------------------------------- --------------- DATE.-------------------------------------------------- -------- Alterations and/or recommendations:-----------------_.__.--_------ -_ .-_. - r i 3 C 4 -------------------------------------------------------._-..------------------------------------------------------------------------------------------------------------------- .,---------------------------- r f FINAL INSPECTION BY: - -------------- Date-- `/J 1� ---- ---- -----_------------------- i y SAN JOAQUIN LOCAL HEALTH DISTRICT 1:601 E.Haialfon Ave. 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi, California Manteca,California Tracy,California f i E.H.9 21A 1.57 Vanguard Press ; 1+