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FOR OFFICE. USE: --- ------------------------------- ------------------- / Z _ APPLICATION FOR SANITATION PERMIT Permit No. �1 / --------------------------- ------- ---._--._.____._.. (Complete-in Duplicate) -__ _.____.---- This Permit Expires 1 Year From Date Issued Date Issued 05`q- - Zzo—DQ Application is hereby made to the San Joaquin Local Health District for a pe mit t con r�t and install the�%rk h rein described. This application is made in.compliance with County Ordinance No. 5494po-?1�---7------------------------. JOB ADDRESS.AND LOCATIO 2is�_. cc. /J --- - --------------------- Owner's Name=-- -zw--- 1,1 --------------------------------- _ --•--- ' --------- hone-------- 4 Address---�-� p 2772--r" ------------------------------•------•-- -----r -- - e I • " ? Contractors Na-,me'----- - - ------ ----- - ----------------='--•--•--------------- Phone.__.....---•-------•-----••--------- D .I Installation will serve: Residence�KApartment House ❑, Commercial [-] Trailer Court E] Motel LlOther E]Number of living units: _.�__.. Number of bedrooms Number of baths_ - Lot size --- ----- - Water Supply:; Public system Community system El Private E] Depth to Water Table ------ - ft Character'of'soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [d� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date_�......... ..... ) Nc ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) rt y i E 1 '4 I Septic ank: Distance from nearest well.... Distance from foundtion---__te.........Material ---#_eX-Pr------------------------ No. of compartments- 2------------------Size_ _ _e LTJ_ -- :_--Liquid depth----.- - -------.Capacity-/,✓��r� Disposal Field: Distance from nearest well- 11 ��Od?� Distance from foundation_..t�'. ........Distance to nearest lot. lineS-------------- C ( Number of lines ------moi--------------------'.;Length of each line---------- v,,_`.._..-.-.Width of trench..4'.0---__--._____--------.--- Type of filter material_-_--_.�.-12.....- -Depth of filter material------If."_-----...Total length___.�.0" . Disfance to nearest well_..:��'p�.. .Distance from foundation---f�'.� .-------Distance to nearest lot line..--�.----` Number of pits--- -.-aq---.._.-_-Lining mate ria 1. 2 -------Size: ......Depth_._./eZ--------------------- Cesspool: Distance from nearest well ----------------Distance from foundation---------------_ _Lining material--------------.----------------------- Size: ----------_r-.._.---_ Size: Diameter- -- --------, - --- - --- ----------Depth------- `--------------------Liquid Capacity----------------- ----;-----gals. +'Privy: r', Distance from nearest well--------------------------.------- ...... ._Distance from nearest building------------------------------------------ -Distance -.._----..------------__--___..___....._._.Distance to nearest.lot line-------- ------------ ------ -----------------------------------'------------- -------- ---- Remodeling and/or repairing (describe):--------- ----------------------------------- --------------------------------------------------- -------------•--.. ---------------------- --------•-----------.- ----------=---------- --------- ------•---- ---------- ----------------------------------------------------------L---- ---------------------------------------------------------------- ------------------------------------------------- ----------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Llawand rules and regulations of the San Joaquin Local Health District.(Signed)------------------ ---.-----.....__---------- --------------------------- ------ ( ^d/or Contractor) yp ... . 4 ------ --- ------------------------------------=(Tltle� � -------------------------------- - - ------ B - (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse si e)j f FOR DEPARTMENT USE ONLY ------ DATE-- 3'6,Y---- "--------- ---- APPLICATION ACCEPTED BY.- -�'---- -�--='�� - -- ---------------------------------------- - ---- REVIEWEDBY----------------------------------- ------ --------------------------------- ---- ---------------------------------------- DATE-------- -= ------------------------------------------- BUILDINGPERMIT ISSUED-------- ---- ---------- ---- ------------------------------- DATE-----------i---- --------- ----------------------------- Alterationsand/or recommendations:------------- ------- ------- --- --------- ------------- -------------•-----•--•-------•------ ---------•----------•------------------- �-�s f --- - -------------------------------------�.----- - .--------- ---- . . ....-- --.. .------.. ----------------- l, r s f � FINAL INSPECTION B - Date-- �.`.. 7 = rp._ -- y SAN JOAQUIN.LOCAL HEALTH DISTRICT t 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 'Vanguard Press