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FUROFFICE USE: ------- ------ ------------ ------------ ----------- ------------ - ._ _ .--__--- APPLICATION FOR SANITATION PERMIT Permit No..c _ •� --------- -------------- ----------------- --- (Complete-in Duplicate) --- . ------------- -------------- DateT_his Permit Expires 1 Year From Date Issued Date Issued lD---�7: 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 ANDLOCATION.j _f -' " . a-,J?Iq--- +�-- ----- ---------- ` Owner's Name--- -- -"V-1--�h'•• -•--- - ------ --�-1�'�.:--.•--- • - -------•- -• � -----•--��----------- , ,�--•--------- - ----- ---- ---- ------- ------------ ----- - Phone. ._� _--�---7�- Address,----•--••---� -.: _.§ :---•---- Contractor's Name Z) - - Phone..---------------------------------- Installation will serve: Residence- Apartment House ❑ Commercial ❑ ❑ Trailer Court ❑ Motel ❑r�/ ``Other � Number of living units: _-/.____ Number of bedrooms ___Number of baths..__-?Lot size f t .fi ..[�[.O-`_-.__-/sem Js� Ty. . Water Supply: Public s stem` J PP y� y ❑ Community system Private �(. Depth to 1N ater_Table'__.__ _ ft n Character of soil to a depth of 3 feet Sand F I Gravel ❑ }Sandy Loam; Clay.-Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ >,I\ Previous Application Made: {If yes,da#e................... ) No R. New Construction; Yes ❑ No FHA/VA: Yes [:] No \ TYPE OF INSTALLATION AND SPECIFICATIONS: t A [No sepfic fank`or cesspo6l pe mi++ed if publicewer•-i -available-w}him 200-.-feet.) -- # -- 3r 3._ z Septic Tank: Distance from nearest well_(! __------Distance from foundation--.�Q_�----.Material �o 'd No. of compartments-____.__5- -------- Size_j*.__ S ._�C_� .---Liquid depth____-1AV/4p Disposal Field: Distance from nearest well _rf.Q---._Distance'frorn'foundation_ >* � ------------------- Distance to nearest lot line___�'._-_•-- ] Number of lines____- F. Length of each line:_--, _�fOO Width of french....... --'_P-.--__ - •� T e of filter material 17 Yp _-_ _._Depfih of filter maferial_ _ ----.--_-Total Iength__ r--_- o0 - 1 • Seepage Pit: Distance to nearest well------ _,.___..__----Distance from fours'dation--------_------------Distance to nearest lot line-____________..._ ❑ Number of pits---------------------Lining material---------------------'Size: `Diamefe�_-�--:--------------Depth.._..._._....--------------- - ir --- Cesspool: Distance from nearest well ---._.___....__Distance from foundation_ __---- ______ _ Lining material_,--------------------------------- Size: Diameter- -- ----------- -- ------ --Depth--- -- --=---- ------- `' --- --- -'=-'Liquid Capacity--------------------- - - - ------gals. � Privy: Distance from newest well..:.............:.:.... .........................Distance from =nearest building______-__..-_.___- Distance to nearest lot line ---- --- 1 Remodeling and/or repairing [describe):-----.------..:..._ ---- ••--•------- ---------------- -------------------- ---------------------------------------- i - ---•---' -.._-------------------------------------------- ---------------------------------------------=----- -- --- --•-- -- ------ I I s -------- ---------------------------------- ---- - - -- - - - - ----------- - - --- -- -- -- - ------ - - - ----- - -- - - -- - hereby certify that I have prepared this application and that the work,will be done in accordance with San J-oa- - ---quin C-ounty- - - - ordinances, State laws, and rules and regulations of the San Joaquin Local:Health District. ¢ ' ► (Signed)----•-- �------e----- ` er -- � wneran r Contractor) By----------------------- - --- ----- ------ ---- -- -- ----, -="-""= "- + -' -----------ffitle)-------- ---- - ------- --' -- „'_-- ..--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED B ""- DATES-------------- - ---- ._. _ _- REVIEWEDBY ------------- ------------L--- ----------------- DATE--- BUILDING PERMIT ISSUED--------------------- Alterations - ----------A+erations and/or recommendations:............... � ------------------r ----------------------- ------ --- ------------ -------Z------------------ FINAL INSP Date_ ---- I SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street f 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press