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FOR OFFICE USE: -------------------- --- ---------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. .__-----------------.--- --------- ------_----- - (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. This application-is-made'in compliance with County Ordinance No. 549. CZfl:Z3' - -?� °''�9 r 22-65 230—o7 JOB ADDRESS AND LO{C''..AA�TION---V%OA .#f110AW_-9 � -_ �� 5'��.%4fl� ¢ Owner's Name-----R-------(#� /�"� _ --------. Phone-- ?s1:? 4-T Address------ - -- #- . ---� --`--- "S�` _.%�/--------------- ------------- --- Contractor's Name---- •------�'� _ Phone------ ---------------------•------ ------ --- ------------------------------ -- ---- -------- ------------------- Installation will serve: Resi ence .t 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 04 Depth to Water TableeoO�Fft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam jr, Clay ❑ . Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date................... ) No 0 New Construction: Yes ❑ \,No * FHA/VA: Yes ❑ 'No:❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ? I (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- Septic Tank: - Distance from nearest well_: _J�©! Distance from foundation_/e_ ----.Material ❑ No. of compartments----_,l-----------.-Size-------:^--"'------_--------Liquid depth_..LO� - --.Capacity__/_X_V ]----- Disposal Field: Distance from nearest well_.__.�.�-_--Distance'-from foundation__,(_._ Distance to. nearest lot line_A—!:__f� - Number of lines--- Length q" L`en th of each line160 _ _'— trench. ' .............W , ___-.__--- --------- Depth of filter material lenth___ QQ ----- Type of filter _ Al Seepage Pit: Distance:to nearest—well__------ --------Distance from`foundation___._________,_.___ Distance to..nearest lot line------ -- - E7 Number of" pits--- ------------------Lining material------------- -L Size: Diameter------------------------Depth- -- - --- ---------------------- Cesspool: Distance from nearest well --------------_-Distance from foundation_..<------------ - Lining material__._...._.._--._ ..___.._.__.._.-_. ❑ Size: Diameter_ __ f i ._Li Liquid'Capacity _________gals. ...._.�_' - ----- - ---- -Depth- ------------ -------`='--- ------ --- q p, Y------------------ Privy: Distance from nearest well__ ------------------` :�:.._._:i-_-:-.__Distance from nearest, building.___.__.__.__.__________.___--.- "---- Distanceto nearest }of line ---_----------_--------- i Remodelingand/or repairing (describe)----------------------------------- ---r-----=---------------- --------------------------------- -------------..----------------------------------------- -------------------------------------------------- - - -------- ----------- ------- -------------------------------------------- ------------------------ ----------------------------------------- "------------------ r. • " -_ ____________________________________________________________,j._.___..•___ 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)----- -- ---• l------- ----------- -- ---- -------------------------- -------- r ------------------ Y:.- ( --lt-l--)----"---- ._( ne r and/or ontrac for - -- ---. - = -- o _ ....._ (Plot plan, showing size`of lot, ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY - - DATE- '- i� DATI 1.x.'-2-$-` 6 ---------- - REVIEWED BY-------------------i-t, -`------ ---------------------------------------- BUILDINGPERMIT ISSUED-------- -- ------------------------------------------------• --------------------- ---------------- DATE----------------------------------------------------------- Alterations and/or recommendations:----- ----- ---•---------------- ----- ------------ -------------- ---•----------------- -------------------------------- --------------------- ------------- ---- ---- ------ ----------------------- -------------------------------- --------------- --------------<_..-. ----------------- • ---- ---- -- - a ! ........ ------ r / , : FINAL INSP_CTI % Date ' �.A [J ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California LocrCGllfornia Manteca,California Tracy,California f " 4 E.H.9 2M 1-67 Vanguard Press 147