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FOR OFFICE USE: --------------------------------------------------------- ------------------------------------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. _.�_. .. - --------------- ------- -------- --- -------- - (Complete in Duplicate) Date Issued `�7z�r ___ ------------_-------------------________ ___________ 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........IA----Z'-�-- !-�T'G7" ------ _t_s�-----------------------4-a1W.-uw Owner's Name----------- 0------- 0. '------ •---------------------- --------------------- -- ------- - ------------------------ Phone------------------------------------ Address f --, ------------- . ------ :2 ------------------ `r Contractor's Name---------- --�------- }------------------------ ------------------ ------ Phone--- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms __J_ - Number of baths _/___.._ Lot size ------ -____________________________________ Water Supply: Public system ❑ Community system ❑ Private [j-- Depth to Water Table _/.Z-_ ft. Character of soil to a depth of 3 feet: Sand E- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C] Previous Application Made: (If yes,date--------------------) No ❑- New Construction: Yes ❑ No B" FHA/VA: Yes ❑ No E— TYPE OF INSTALLATION AND SPECIFICATIONS: v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--4A_ ----Distance from foundation---/�t---------- ------------_______ No. of compartments_-------Z____----------Size------ _ _`t_/__Liquid depth------- __f.....__._...Capacity---ov-u. Disposal Field: Distance from nearest well____,.%0_r..._Distance from foundation ...... --Distance to nearest lot line__ -------- �G Number of lines-------------/____._______.__._Length of each line--------JrQ___--______._.-.Width of french -------------------------- I XI,lop 1, Type of filter material.__.__ea.5_&_Depth of filter material......Jof-"----_Total length___�6__--______________--___---_____- � Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- N Number of pits----------------------Lining material---------------------- Size: Diameter----------------------.Depth----------------------•------- --- }� Cesspool: 1s a from neare6 well-----------------Distance from foundation-------------------.Lining material----------_-__._____._____.._______- (�J ❑ Size: Diameter----- ------------------------------ Depth------------------------------------------- --------Liquid Capacity----------------------------gals. `�'� Privy: Distance from nearest e11 .._.- _.-____________________________Distance from nearest building. _-__.____.__________..__-_-_ / ❑ Distance to nearest lot line-------------------------- ----------------------------------------- ---------------------------------------------- Remodeling and/or repairing (describe):-------- P.[. —------.-t-D---- -- �-1 -- --- `-` -- -.----.. 4--- T e --------------------------------------------------------------------------•--•---------------------------------------------------_-------------------------------------------------------------------------- -------------- 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. (Signed - -- --------------- / -------------------------------------------------- ------------(Owner and/or Contractor) gY- --------------------------------------------------------- -------------------------(Title)---------------------------------------- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----" +._ _, Q `------ ----------------- ---------------------------------------- DATE------------5_7�71_S'_45.S- ----------------- REVIEWED BY------------- --------------------------------- ------- -------------------------------------- DATE------------------- ---------------------------------------- BUILDING -------------------------------------- BUILDING PERMITISSUED------------------------------------------------------------------------------------------- --------- DATE------------------------------ ----------------------------- - --------------------- Alterations and or recommendations: ---------------- ------------------------- ------------------------------------------. ------------ ---------- r ivA 11pCT1- nlr ._19p._ t -Efts----- t3� JNT1_�t- 1� S1�Fra ,c _i-._ ------------------------------------- ---------•--------- ------- ----------------- -------------------------------------U, '� > t FINAL INSPECTI �� -r Date :.. --- G----------- --- ---- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California + F.F.0 C. 1