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FOR OFFICE USE:- ----------_--------------------------------------------- _ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- {Complete-in Duplicate) Date Issued ---/_-r-4,7- ........................:..........._.....____..__...._.. This Permit Expires 1_Year From Date Issued_ �-s?-- -2-o--(O 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. 01 + �!PO/�►� _ c y- JOB ADDRESS AND OCATIO ------------------- ALTO�--------R ..._ .c Ot- --/CJ9 _ -------- z Owner's Name---------- IPA N-U-F4=---------.__1_Co_5-riq------------------ ------ --- - - - ------------------------------------ Phone--------------------------------------------------- �4 Address................g5g7-------- .- ----- ---------•---------------------- ---------------------------- ------------------------------------- Contractor's ------------------------------------ t Contractor's Name------ ---4.141'_F-h.-------------- ---------------------------� --- ------- -'---------- ----'''---- Phone------ -------_------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of livingunits: __ e l�__=_ Number of bedrooms___ Number',of baths-2 size -_ � �?�.________________________ Wafer Supply: Public system ❑ Community system [] Private �epth to Water Table.-- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel,❑ Sandy Loam lay Loam [:] Clay E] Adobe ❑ Hardpan Previous Application Made: (If yes date_-----.Jul ) No ❑ New Construction: Yes ❑. No ❑ FHA/VA: Yes ❑ No [ rn--i _ F.ISNSPEC w� --TYPE OS {No septic tank or cesspool perm6fed if public sewer is available within 200 feet.) l Se tic Distance from nearest well from foundation_..__ � p 1 ------.Material --��/VC-RST-' No. of compartments...--._.__" ......Size__ X.Q._ _ ,Liquid depth... V-- .�-.CapacitY__._f_�__�.O___ Disposal Fieid: Distance from nearest well.....5_ .._Distance:from foundation-__./_ `�::Distanc$-to-near"%t lot line____._-____. 7, v:._,-a , ave f ^' 7r Number of lines_- Z _Length of each line-- ----q.9--------------Width of treii lh J___12- ___ ` Type of filter material._.__ . ____Depth of filtef materiaL___._.19.__-___..Total length______ ------ Seepage Pit: Distance-to nearest weir-'_-_"-.ry-�"-`Distance from-foundafion._=_____ "_____.Distance to nearest lot line__._____._______ ._._... Size: Diameter-----------------------Depth-- ------------------------------ Cesspool: ----------- ❑ Number-of pits... ------------------Lining material.__-r-._._-. --__-._. Cesspool: Distance from nearest weld ________________Distance from foundation-----------.----- ..Lining material-._---______._..____.__.__-.________- ❑ Size: Diameter- -- -........--'-- --- -----------Depth---------------- ----------- - --- -------- -------Liquid Capacity----------- ----- ----------gals. Privy: Distance from nearest well...----------------------------------------------Distance from nearest building--------------------------------........... ❑ Distance to nearest lot line-•------------------------------ ------------------------ Remodeling --------------Remodeling and/or repairing (descriLe):___............. --•------------------------------------------------------ j4 x --------------------------------------------------------------------------------------- -- - i ---------- ------------------------- --- --------------------------------------------------•-----------------=A.:------------------=-------- I hereby certify that I have prepared this application and that theTwork`will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) --- --- ------ -- (Owner and/or Contractor �Y� " -----------------(Title) ' - - -..._.... -- - ---- --------- (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse_side). p FOR DEPARTMENT USE ONLY �y APPLICATION ACCEPTED BY-- ----- ------------ --------------------------------------------------------- DATE-------f -� r REVIEWEDBY----------------------------------- ......... . ' ------------------------------------------------------------- ----._ DATE-------- BUILDINGPERMIT ISSUED-------- -- -----------------------------------------------------_---------------- -'---'-' -------- DATE------------------------------ -- ------------- Alferafions and/or recommendations:---'-'... --'-'-.. ------------ ---------------------------------------------------------------- ------------ ---------•-----•------------- -----------»__. __-- _._------------ .- fC. _ � - L_.. �4�Ydc. : ate_-.__p+4T' : � - -------- I ------ -- ------------------ - .. --'- ... f�-TrAC.tf+ D- - -- --`- —_ --'-- - ' ------------- ...............----------- ----------- FINAL ' ' " ' - - FINAL,INSPECTION BY:_// •--------------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California `° Manteca,California Tracy, California I E.H.9 2M 1-67 Vanguard Press I