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_ FOR OFFICE USE: �1307WS, C Q y -Z -------------------------------- ------ ---------------- 'J APPLICATION FOR SANITATION PERMIT Permit No. _.. �..... � -------------------------------------------------- -- (Complete-in Duplicate) Date Issued -_.-_------ ---- ----- ---.--------_-._-.-...._.-.-.. This Permit Expires 1 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. JOB ADDRESS AND LOCATION__r_ _ _��. ... - (11 AvaU,( .... Owner's Name-----------------------------------�N i f2 --- ---------- --------- ------------------------------------ Phone------------------------------------ Address------------------------------------------------(-�..,.,, ------------------------------------------------------------------------------------------- ---------------------------------------- 77 Contractor's Name------- �.Que. t 1 ovib---_------------------ ------------------------------------• ................ Phone.. _-9,2.3793 Installation will serve: Residence IGRIApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .___ Number of bedrooms . __-. Number of baths---I.. Lot size ----- .__ � t� - Water Supply: Public system [-] Community systemr ate ❑ Depth to Water Table .:(-°l_ ft t� Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3--Hardpan ❑ _Q Previous Application Made: (If yes,date------------------- ) No ;;�- New Construction: Yes ❑ No a FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,Nov*7-W �c (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well .__�--�..._Distance from foundation--.1v___-. .Material ----- P;1_14 _-_ ..................... �/ No. of compartments---------P._.___-_---Size---�_?��0�__5-----------Liquid depth--.- /_i -- ------- Capacity_J Disposa Field: Distance from nearest well ......Distance from foundation.-_40..........Distance to nearest lot line---,..?'`�_�_....... Number of lines--------------- -..-.-____.__Length of each line.- _____--__ -----------Width of trench------oZ-________--_--.-.--_.__--_ Type of filter materials I G._._-_Depth of filter material--------/ff."-`__--Total length------------- :7- ..__-_._ Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line_-___-_-_-.-__--. p Number of pits---------------------Lining material-----------.--.------- Size: Diameter---------_-----------Dept h-------.------------..----------. 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):--------------_- ---------------------------------------------------------------------•-----------------------------•---- _-_-------------- " J ..-•---•--------••------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------•-------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ---------- ---------•--------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------.. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County pl ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. $1 (Signed) �p- ----------------------•-------------------------------- ---(Owner and/or Contractor) Byl --C�-- -------------- ----- --------------------------------------(Title)---------- ------ -------- - - (Plot plan, s owing size of lot, location of tem in relation o wells, buildings, etc., can be placed on reverse side). FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY-------- DATE------- --- .-. . ------------------------------------- - REVIEWED BY------_----------------- ---------- ----- ------ DATE------------------------------------------------------------ ----- PERMIT ISSUED------- -- ------ DATE---------------------------------------------------- Alterations and/or recommenda Ions------------------ - ---._..------------------ --------------_........................................................................................ ----------------- ----------- -------------- -----------------------------------.------------------------------ --------------•---- ---------- ----- ------------------------------------ -------------------------------------- --------------------------•----------------------------- -----•------------------------------------ ---------------------------- -------------------------•----------------------------------- --------------------------------- - -------------------- -------------------------------------- --------------------------------------------- --------------_ -------------- -- -------------------------- FINAL INSPECTIO - {date lP..l�-�� . AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press