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FOR OFFICE USE: ----------------- - ---.---.- APPLICATION FOR SANITATION PERMIT - Permit No. .__..___._.-'......� ----------- ------------------------------------- -- (Complete•in'DuDate Issued plicate) _----__-_------- --- This permit Expires y Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATON------ -_ 7/__3_,0------ ------✓�w. ,'------------ ------•------------ Owner's Name---------- ---- ---------------------- Address -------------------------------- Contractor's Name------------ I � , Phone� 6. A------. Installation will serve: Residence Q�!Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units; . ----- Number of bedrooms _7_ Number of baths _/... Lot size _.__ Y11 -------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.110_ _ ft Character of soil to a depth of 3 feet-, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay eAdobe eHard an Previous Application Made: (If yes,ddte__ ) No [ New Construction Yes ❑ No.DR"." FHA/VA: Yes ❑ No J2`0' f TYPE OF INSTALLATION AND SPECIFICATIONS: _. s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from.foundation-___' t__.....Material ----------- ---------------------- No, of compartments------- ------ ...Size----------�:_.._.=i- --------Liquid depth--------- - Capacity----------------------- F-1 f r Disp�o,s/al Field: Distance from nearest well-/[spy-,P---Distance from foundation_,��__.___.._-Distance to nearest lot line_____..___.. 99 Number of lines-__�._____.�_j_____-_____�. Length of each line__..._____-V_0-`.-_.._.,.Widths of french._____�_.�_''_-.--- � d Type of filter material--/-?� ec..r...Depth of filter material___xl17.�_�._____-'Total` length--------1VC1_'_____________________ 1. . See�pa/ge Pit: Distance to nearest well_4/j#_*F........Distance from foundation--- '_.Distance to nea"rest lot line____ t Number of its--- : _ p l�.__.._-_---Lining material--`----s IPc,eSize: Diameter_--, "-----_-- Depth------' - L Cesspool: Distance from newest well ------ ---------Distance from foundation......... ..Lining material_________________________ ____ El Size. Diameter. ------- ----- =--------- -----Depth------ ---------------------- - - - - ---------- Liquid Capacity-----k--- ------------gals. Privy: Distance from nea#est we€L_______----___---------- ------ ---------------Distance from nearest building---------------------------------_---- r ❑ `-..Distance to nearest lot line --- --- ------- ----------------------------------------------------- Remodeling ---------------------------------------------•----Remodeling enc}/or repairing (describe): a r - --- ----=------- - - - --- - - ------------------------- ------- --- -- --- --- -- ------------------------------------------------------------------------- -------------------------------- ----------------- ----------------------------------------------- I hereby "ifha 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and .egu eQns of the San Joaquin Local Health District. (Signed}[_-- - -�_-. .........................(O er nd/ojp6n�fracforj' -------------- [^ By:. - - — CA r {Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse si ). FOR DEPARTMENT USE ONLY . J� l APPLICATION ACCEPTED BY------------ '----`----------- --------- ----------- ------------------------- -------------- DATE 6�- I REVIEWEDBY------------------------- -------------------------------------------------------------------------------------- ------------ DATE BUILDING PERMIT ISSUED---------- ---------- ------- DATE---------------------- r Alterations and/or recommendation: f rll�6 A '_4i�,.--- -- '---------------------------------------- ------------------------ ------- -- -- --------------•-------------------------- -------------------------------- FINAL INSPECTION BY:--------- ----------------------------------------- Date---- ......----------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton 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