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FOR OFFICE USE: ---------------------------- - ------------------ ;----- --.-W,----. -----------.- APPLICATION FOR SANITATION PERMIT Permit No. . .oaz. � --------- -------- --------- (Complefe-in Duplicate) This Permit Expires 1 Year From Date Issued 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 p�j lication is made in compliance with County Ordinance No. 549. x, JOB ADDRESS ANpD�LOCATION.-.. o- --- ..L -C.,ck O�jn �r Owner's Name-- /-�-0 -- -'---------•---------------•---------- ---------- --- ------------------------------------------- Phone.4�-�_~_.73-$-7 Address---------A_T_ __a-ax...... - 0--I i� 5-C--A.1_-9 Nj- A --J-�r Contractor's Name-------•-14- /t'1 E-- -----P4 ut,_------ o�� -.I CxT f •-..----------•-. ----------------- oo Installation will serve: Residence 0- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1--.- Number of bedrooms -.�-- Number of baths__j..- Lot size----.A-_�-.� --------------__.- Water Supply`s Public system ❑ Community system ❑ Private f6�—DepA to Water Table,9L4?- -'ft Character of'soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[) Hardpan ❑ I Previous Application Made: [If yes,date.- ..,__� _}. No,- New Construction: Yes ❑ No FHA/VA: Yes ❑ No e_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welIS-D---------Distance from f undati t- .-__-_--__ Material ---�Ce&cl r7" No. of compartments---_-_-�---------------Size----- y i uid de th._.h�.-_It------ Ca acit -y's-o"r---.--- - � � q P. � p Y•• - Disposal Field: Distance from nearest weEl._6 P_-------Distance from foundation---L D-.-----.-.Distance to nearest lot.line_t --------- Number of lines---�____p_________________..__Length of each line--LIQ--------------------- Width of trench---IZ�____________---_._--- Type of filter material_9_0-.C1(7------_--Depth of filter material-- _4�---------------Total length-----!Rr0-----_----.-----.------------- Seepage Pit: Distance to-nearest well--------_-------____-_Distance from foundation__------------.- Distance to nearest lot line-_--------------- 1 ❑ Number of pits... ..................Lining material----- ------------- Size: Diameter---._-----------------Depth-----.--------.------------------ p non Dining material------------------------- Cesspool: Distance from nearest well -----------------Distance from f��,da, [] Size: Diameter -- ------ _---,> Depth------ - =" =-------------------------Liquid Capacity-- ------ ----- --- ---gals. Privy- Distance from nearest well_______________:._____._.-.--_...._._.._......Distance from nearest building----------------------------------------. J ❑ Distance to nearest lot line ------------------- p f Remodeling and/or repairing (describe): A-b-Q.t-s1-Cr-:--- ---9-0-- v*--- ----Q;--------.-L.+1�A�.1.1------� � �_- ----•-r6 ------------- Xl `�T t �'` I =--------s ST -M ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------------- I 1 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.H,ealth District. `_-- - - --(Owner and/or Contractor) Title - w. �..._�= .. By:----------------- - ----- )------ --- ---- --- -------------- .. [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,tcan be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 - Q---------------- ------------------ - ----- DATE------------- ---------------- REVIEWEDBY------------------------------------------- ----------------------------------------------- - - ----------- ------------- DATE------------------- BUILDING PERMIT ISSUED-------- -- -------------- --- -------------------- --------—----- --- - -------------- DANE--------------------- Alterations and/or recommendations: .. l�Nj� ---- ----------- -------------------- ---------------- • --- .......... - ---- --- -------------�--------- --- - ---------------------------------------- - --------- -- ------- ---------------- - ---- ---- -- ------------------- - - -76 FINAL INSPECTION B i - Date------- --------?�f t 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.92M 1.67 Vanguard Press ti