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FOR 'FF.-_.":USE: ar APPLICATION FOR SANITATION PERMIT Permit N'O. .._.____-s�71 " ---------- ------------------- ---------------------- r --------------------------�------_...._.._-- t (Complete-in Duplicate) ---- - �- � ' bate Issued ----- --- --------------- -------- t This Permit Expires 1 Year From Date Issued I Application is hereby Aacle to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance}witthh County Ordinance No. 549. JOB ADDRESS AND LOCATION----�_,1- 3�-}--- ----- I -� Owner's Name..,, r�� -------- -- ---------- Phone l lk Address----- ��..___-s-P- = ---- - ------------------------ -----------------------------------•--•---•----------------------- -------------------------------------------- Contractor's Names --k - Phone - --- -- ---- = - --- _ t Installation will serve: Residence [!]- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _-,3. Number of baths _1-_-_ Lot size __-%Jrvix- Zc1 Water Supply: Public system jKto`mmunity system❑-Private❑ 'Depth'to Wafer'Teble"_bft Character of soil to a depth of 3 feet• Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------------- } No [ New Construction: Yes U?`1N_o ❑ FHA/VA: Yes 2----No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 /� Septic T nk: Distance from nearest well__ Distance from foundation--t-0---._---_--Mator�aI ..._(, "?''t{�d�________________ No.t of compartme'nts----I------------------size-------3�.Sx-_1----Liquid depth----.--j_...... _...__Capacity--.4--�Q_V--- } Dispos :eld: Distance from nearest weh__'__-_.._ -Distance from foundation---w-------------Distance to nearest lot line �_J____. � Number of lines.__.l`_' _ _.___.__..---Length of each line--.-'7%S -------------------Width of french_____--�1..�_.__--------------- `U Type of filter material__ _ -___S.,r..k-----Depth of filter material-jr-11.---------Total length----.yam-_ ----___------------------- Seepage Pit: Distance to ne res est well....'` _._._..._Distances from foundation___!S-_ 4� . _______Distance to nearest lot line �_-_-_. Number of pits---I-----------..Lining material_ T1 0_L:k_ Size: Diameter----3.3_`_,--------Depth_._ Y7_/_____________ J 5 Cesspool: Distance from nearest welt ................Distance from foundation----------------- . Lining.material_._.---------------------------------- ❑ Size: Diameter- -- --------- ----- ----- ---.-..-.Depth---------------- --------------- - ---------------Liquid'Capacity----------------------------gals. Privy: Distance from nearest well______ __________ _____..__._.....------- Distance from nearest building-__.i_.______..____-________-..-... ❑ Disfance to nearest lot line ----- -_-_---__.:.:----------- ------------- -------- 4 �G - ; Remodeling and/or repairing {clescrib` ):------- ' -'� :; �� / � 1`------AP-`P ----------------••------•- ---=------------- -------------- ..---- - ---- ----- -- - --- --------------•---------------- ----------------------------------------------------------------------------- ------ 1 i € f If t ". r ``rv .. , -------------------------------------------------------------------------------------------------------------------------------:-- :;--------...----------------------------------------------------------- I hereby certify that I have -prepared this applicati n and'+hat'the,work will be done in accordance with San Joaquin County ordinances, State la and rules';ano re mations of the San Joaquirr`Local Health District. I Ar (Signed) ----------�tn - ------ --- ------------- -- ----------- ----------------------------------- ----------- ------ h or Contractor) u By:----------------------- -------- ------ - -------- - -----(Title)--------------- -------- -- - ---- -- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t- FOR DEPARTMENT USE ONLY ! ' APPLICATION ACCEPTED BY `�- -------- a te DATE '17_ I. --`� � REVIEWEDBY------------- -------------------- -------- .---------------------------------------= -----------------------------•-------- DATE----- ---------------------------------•------------ BUILDING PERMIT ISSUED.------- � -- t------------! ------------------------- ------------ ---------------------- DATE----------- ----- ------ . ------ Alterations and/or recommendafik i ---------------------- '� -------- --------------------•--------- ------ ---------------------- --- _... --------- ------ - ------------------------------------ ---�— - -- .. / - -' �bate.------7 - -------- -------- ------------------------------- -- -FINAL INSPECTION BY: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.fta:elton Ave. 300 West Oak Street t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press .. i