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FOR OFFICE USE: c .. --------------- - ss77 ----------------- -- ------ --------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) Date issued This Permit Expires 1 Year From Date Issued 710-401 Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta" the work herein described. %application is made in compliiance with County Ordinance No. 549. YV1ITC.(-7Q S - TACr- TD �-*Z- ) if �J JOBtADDRESS AND LOCATION .�l C_K.TCN -� -x 1-----='-�----- f C Owner's Name-------- -------�!__� PSI.�------------ �'I' A - -------------------------- ------------- Phone------------------------------------ Address----------------J-- 3 -5_0---E------�L)1-S-�-------P-V-�------------------------F)-P-0tv--. -- --•---------------------------- -------_-- Contractor's Name----&`-WZ4E-R------------------------- ---------------------------------- ------- -------------------------------------------- .. Phone------ ----------------•----------- Installation will serve: Residence [,+Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ -- Number of living units: _____ Number of bedrooms _ -Number of baths --.L- Lot size _.._ --_______-_-_-----._- Water Supply: Publics stem Community system Private De th to Water Table 1. _ ft O PP Y� Y ❑ Y Y ❑ � P Character of soil to a depth of 3 feet. Sand VGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [-] Hardpan Previous Application Made: (If yes,date------------------- } No New Construction: Yes ❑ No �HA/VA: Yes ❑ No TYPEOF INSTALLATION AND SPECIFICATIONS: _ y - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t .. Septic T Distance from nearest well.....5�.__Distance from foundation__-�-0........ Material r__ t' /fit-C_� _ _.t. .. ..... No. of compartments...__..-2=-------------Size�:�G/.-A __._:___Liquid depth.-.-_---.'�nce� —_Capacity--- p.�- - Disposal Field: Distance from nearest well.....5-0 Distance from foundation---.-10--_-----I ito nearest lot line---�_.-.__--. rr Number of lines------------I.._ .________..___Length of each line__ ___l��.--- Width of french-____-__r.�_�._.__..._ Type of filter material----/3®G---- -_-Depth of filter material----...1 ______--Total length-------------------/f.Q-.-----.--_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__._-_-__.._--__ ❑ Number of pits--- -----:---_---.----Lining material--------------------- Size: Diameter--------------_--------Depth-----------------_------------_-- Cesspool: Distance from;nearest well ----------------Distance from foundation............- -_ - Lining material--------____--._._..._.._-_-_-_._ ❑ Size: Diameter- -- ------ --=- -- ----------------Depth---------------.---------------- - ----------------.Liquid Capacity----------------------- ---gals. Privy: Distance from nearest well_...............................................Distance from nearest building----------------------------- ❑ Distance to nearest lot line -------------------------------- --------- ------- ------------------ ---------------- -------------------------- --------------------- Remodeling and/or repairing (describe)---------- ------- - -------------------------------------------------------------------------------------------- ---------------------------------- - ----------------------------------------------------------------------•---------------------------------------------------------- ---------- --------------------- - 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. (Si ned j� 9 }-------�-`-=� ----,•-- ----=- �-��—"-------------- - ---- - - ------------ --------------------•---------- -- --------------------(Owner and/or Contractor) BY:-----------------•----•---------- ------ -------I-_------------------------------ ------------------=- - -------------(Title)----------------- -= ...... - - -- (Plot plan, showing size of lot, location of system in relation to wells, bui ings, etc., can be placed on reverse side). FOR DEPARTME USE ONLY APPLICATION ACCEPTED BY.—=M,.-P=- -------------- -- ---------------------------------------- DATE--------- ------ REVIEWEDBY------------------------- ------------ - - -------------- ------------- ------------------------- ------------------------ DATE------.---------------------------------------------------- BUILDING -------------------------•- -- - - --------------BUILDING PERMIT ISSUED---------- ------ ------ ---------------------------------------------------------------------------- DATE------------------------ Alterationsand/or recommendations----------- ------------ ------------ - --- - -------------- --------------------------------------------------------- ----------------------------•--- ------- ------------------------------------ --- ----------------------------------- --------------------- ----------------------------------------- --------------- - --'------------------------------------------------ --- ------------------------------- ----------------------------------r------------ ----------------•------------------- ----------------------------- --- - ----------------- - - - --- - - --------------------- ------------.------------------------------ --------------------------------- ..--------------------- ----;-i•------------------------ ---------------- --------- .... - . --- -- -------------- ----- FINAL INSP N 1 • . - _ Date------------ ,7- ---------------------------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press i