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FbR OFFICE USE: 73 - 97 ------ ----- --- - APPLICATION FOR SANITATION PERMIT Permit No. ............. ...'---- -- '---------- -'----------- - - 7 (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. p �'with County Ordinance No. . JOB ADDRESS AND OCATIONs, This application is made m com lianc ' 549 ��-�°�' ` - --- ----•----------- _..ss _�-� - / -�-- $-�`-� I Owner's Name---- Phone------ -------- i = q D, �� - --- --- ------- Address----- - •-- -- ----,�--------- - , ------------' ___--- ------------ Phon0*;7 121 ------- Contractor's Name-Installation will serve: Residence ,Apartment House [ICommercial E] Trailer Court ❑ Motel ElOther E] Number of baths' a- ---------------- i Number of living units: --/--._ Number of bedrooms Lot size ��.__v '.�'- -----'•------- Water Supply: Public system ❑ {Community system ❑ Privaye Depth to Water Tables - ft I li—-' _ Hardpan Character of soil to a depth�.of 3 feet• Sande Gravel'❑ "'Sandy=Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ ❑ - -"--- ._l 'No Previous Application Made: (If yes,date---- ] .New_Construction: Yes No L:] FHA/VA: Yes 0 No E] sTYPE OF INSTALLATION,AND SPECIFICAaT10N5 —(No septic taniK o�cesspOol pe�mii4tted:if pubI c- ewer,i"vailabie within 200 feet.) . -� --m ,�.•�,, ,.. �� ,-�•�,-.�� ---- ----- ..Material ^------------------- $eptic"Tank""""��Distance"'�rom nearest welL . �-Distance from ffou/nd tion_ .-_ v� � Siz _6q �- �-y V�' -•-- Liquid depth--- 7- (. ---- .Capacity/ 1� No. of compartments..._3---- f - f �Y` Disposal Field: Distance from nearest w �d.A.-Distance from foundation_o�sQ...--------Distance to nearest I line-IM._.._._.- i 2 -- Number of lines.!---_�---...-- -µ Length of each 4ine_. . r?- -`----_- --.Width of trench_ `! Type of filter materlaL.� _ - Depth of filter material_. -------_____.. Total length--- VO' Illy Seepage Pit: Dumber to ntsrlst well - Distance from foundation------- to nearest lot line_..._._._____..- ------ Size: Diameter------------------- ---Depth---:----------------------------- � ' ❑ � pits.,--. ---------- --- Lining material------...------ Cesspool: Distance from nearest well ----------------Distance from foundation-_---------..... ..Lining material-------------------------------------- I ❑ Size: Diameter. = -------- ----------------Depth--------------- ------------------------------------Liuid Capacity ----- ----- ----- -------gals. ' To' Privy: Distance from nearest well____--------------------- - Distance from nearest building_._.__-____.----------------------------- r ❑ Distance to nearest lot line -------- --------------- --- ...........--'-----------------------------------------------------•- - ------------------------ Remodeling and/or repairing (describe)---------------------------------- ------------•----- to - ----------------------------------- ----- ----•------------------------------------------"- ------•--•-------------------------------------------------:i ' - ---- - -------- -- •----- - - ---- - done I hereby certify +hatndhrules endareduithi ations plication the San Joaquin LocaikHealltheDistr District. accordance with San Joaquin County ordinances, State laws, a r 9 ' �- - ---------- ---------- -----•-- ---------- - Owner and/or Contractor) (Signed}---G) .A. -�- --- --- -..._. - Xal ---- -------- — (Title)- - -- - ---_------------------ sy= r (Plot plan, showing size of lot, location of syr+ in relation to wells, buildings, etc., can be placed o reverse side). . --�- - - - FOR DEPARTMENT USE ONLY y G "----------------------------------------------------------- ----- DATE � < APPLICATION ACCEPTED BY_ DATE-------- ------------------- REVIEWED.BY------------------------------------ -------------------- -------------- ---- ---- DATE----------------- ------------- j BUILDING PERMIT ISSUED-------- -- ----------------------------------------------- ---------------------- } - Alterations and/or recommendations--------.---------.-------- -- --------- --- ----------------------------------------- •------------------------- ----------------- ----------- ------- ----------------------------------------•- ------------- ----- -------•------------------- i ....-.--------- FINAL iNSPEC L -.. Date------140!-------6�' f---3z---------- - r SAN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press