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FOR OFFICE LIS I� _-----------------------Z---------------------------... : APPLICATION FOR SANITATION PERMIT Permit No. ------------------ -------------------------------------- (Complete in Duplicate) ?� ------------------------------- ---------------.--- This Permit Expires 1 Year From Date Issued Date issued .........�..... ....� Application is hereby made to the San Joaquin Local tHealWDistrict for a permit to construct and install the work herein described:" This application is made incompliance with County Ordinance No. 549." JOB ADDRESS &ND CATION -_-_- /I�v� l---- ._> - .._ .Vti�C_`.� -------------- LO -- -• s: -• Owners Name ' - •�.'--- a --`---. ------ - ------------ Phane. ___- .D r - -- -- --- ---- - Address----------� f-- = t � G --� ----•••••----•-•--------•-•-••--••-••-•- .............................. - d�r- Contractor's Name .. r. ,.. T�r� Phone .._ -installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r, r I Number of living units: __/_ umber of bedrooms k.Y- _. Number.`of baths ./__ Lot size ............. Water Supply: Public system Corliriiunity system ❑�� Private ❑'Depth to Water Table 4-Q- ft. Character of soil to a depth of 3 feet:( Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam 99-"61ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (!f yes,date--------_-----------I No ❑ New Construction: Yes L' No ❑ FHA/VA: Yes R��'No ❑ I TYPE OF INSTALLATION:AND SPECIFICATIONS: C� (No septic tank or cesspool permiHed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well;VAPO..Distance from foundation-_ _. _::__.Mateflal_ ____________ __ _ ____________ No, of compartments____ ---------__....Size" ' --_____.---Liquid depth___ ...____.._____._Capacity...... . ! 1 f j �I Dispose! geld: Distance from neares# e I�_~../��.__ -_Distance from foundation__ __D._....._.Distance to nearest lot line.... .......:... Number of lines_ '_ _ ___ Length of each line -- - Q'VQ.Width of trench.___...�.P..... ............. Type of filter material..S'�r _ _'.Dept},of"filter material'._,/ g - ------------Tota! ten th---...::....----....� . Seepage Pit: Distance to nearest well_______________"____Distance from foundation--------------------Distance to nearest lot line_______________-_ E 0 Number of pits---f=-----------------Lining material...___._•----...._. -Size: Diameter-------------..........Depth................................. � I - � is -Cesspool: Distance from nearest well_________________Distance from foundation___.________.__.___.Lining material..................................... ` El Size: Diameter__.$-------- ________ -_Depth--------------- f . Liquid Capacity __gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ ❑ Distance to nearest lot ling______________________________ e � I { Remodeling and/or repairing (describe):----------------------'------{----------•--........._-.. --------} ` ----------------------------------------------------------------- F € IL -----------••--•-----------------------•--------•--------------------------------------------------------------------------------------------------------------------------------------•--•----------------------------------- ----------------------------------------------------------------------------------------------------=------------•-------------------•--=----------------•------------------•------•-----•--------------•------------------- L i E L1_ J i • -------------------------------------------------------• ---•--------------•--------------------------------------------------------------F--•-----------------------------------------...----•-------------------------------- II hereb c rt fy that I have}p ared this application nd that the work will)be done in accordance with San Joaquin County ordinances, to law r I reg{llat' ns of the n Joaquin Local Health District. ' (Si`reed 9 -- -- ---------------------� ---:••4= - --• -- - --- -- --- -----------------------------------------•----- -- - ---- wner and/or Contractorl ------Title B : ----------------- (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). _FOR DEP T ENT SE ONLY i 1 1 1r PR:LICATITON.,ACCEPTED BY----- ------- --------------•----... -•-•--_--- DATE_____5 - REVIEWED BY ... ----------------------------•--- DATE---------- •--••--_.._................ BUILDINGPERMIT ISSUED............ ." •------ ----------------------------------------........................... DATE----------------------------------------------------------•- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------=----------------------------------------------------------------------------------------------------------------------=--••-•-------------------------------- • � 1 f. . _ .s-..=5__-------------------------------- ------------------__---- ____________________________________________________________________________________________________________________ _ ______________________________________ i f 4"' ' tl � __________________________________________________________ _____________________________________________________________________________________________________________________ _ ______________________________________ - y -�-- y...wn.._a s ��dd i • FINAL INSPECTION BY1 `_e -_ - . ._� , Date y .._.: '-�� SAN JOAQUIN L4GA'LSH'EALTH DISTRICT ` F 130 South American Street 300 West Oak Srrow 124 Sycamore Street 205 Wast 91h Street Stockton,California Lodi,California A. Manteca,California Tracy,California E8 9 REVISED 8-59 ZM 6-61 All-AS