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fUR OFFICE USE: � 1 ----- ------------------------------------ ------_---.- APPLICATION FOR SANITATION PERMIT Permit No. ------- ------------ --------------- --------- ----- -- (Complete-in Duplicate) Date Issued _J�_ 'Z�G 7 Application ,s hereby made to the San Joaquin Expires 1 Year From Date Issued - �— 9930--0(' Local Health District for a permit to construct and install fFie work herein described. This appl,cafion is made in compliance with County Or finance No. 549. �- 41 a J08 ADDRESS A OCATION- 0.---+-1- -- --- � --fixe " ` rte. /..✓- �� Owner's Name------ �.- ----- � -- �`1 Phone -- �I -C-�.� Address �`------------ -- -----... - -� i - __ -" f oo, ---------------- Contractor's Name---------- - -- --- -- .--__-----_--_- hone___ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑s Other ❑ Number of living units: -- ----- Number of bedrooms 26_- Number of baths -1----- Lot size _ l- - Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Claya �y Loam ❑ Cly ❑ Adobe �` Hardpan ❑;-`� Previous Application Made: Ilf yes,date---.--------- - } No New Construction: Yes ❑ NoFHA/VA: Ye�s [INo TYPE OF INSTALLATION AND SPECIFICATIONS:r---j X. (No septic tank or cesspool permiffed if public Sewer is'available within 200 feet.) Septic Tank: Distance from nleaarest we.4_/ -.__- -----------i1-pista from foundation-.__ - ----- _ a`te�riail f,_- rI --- __. ---___- _ .--- Size of compartments----- -- iquid dtha acitY--- -�-- _- --------------- ----------- e _----- Disposal Field: Distance from nei resf well.1- _.Distance from found --ation--� - _.-.Distance to nearest of li7e--- -. Length Number of lines.-_ -- _i_, of.each line-. - -- �`------ � Width of trench - --- e Type of filter material__ � a _+° .Depth of filter materia .._- --r� Total length-------------------------- ----- ---- -_---- -s - -.-_-- .-.Seepage Pit: Distance to nearest wellDistance rom ` -- .f undation- ----.-.D'- _ nearrest_ lot lin -s Number of pits " -70 _'" 0 ._ - e: Diameter---- . -_.--__ .. � --r'9---Cesspool: Distance from nearest well ----------------Distance from foundation------------ material----_--- .--.--,_ ------------------ El Size: Diameter. Depth`------ --------------------- Liquid Capacity gals. Privy: Distance from nearest weN_:_.-.___ --------------------------- Distance from nearest buildin g -------------•-------------- ❑ Distance to nearest lot line _..-.-.-__----------------__..---- ---. R t - --------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe - .- '"� --_ # --------------------- i _ -+ ---------- - --------•------------- ( -- - p ---- --------------- - ------ ------- 4 -1 hereby certify that phnavep !red this application and that the work will be done in accordance wifh San Joaquin County ordinances, State laws, an 'regulations of the San Jo quin Local Health District. Al(Signed)_ � -.� e .-- wner and/or Contractor) ' BY: - = ---.rte _ rifle [ ) r � ----------- {Plot plan, showing size of lot, location of system in relation to we, s, buildin s, etc., can be lace an reverse 9 p � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '- - ��__.- DATE-. EVIEWED BY. -------------- ---------- ------- DATE----- -- ---------------------------------------------- BUILDING PERMIT ISSUED-------- --.------.--_..• DATE--_._--- • ,e'-- Alferations and/or recommendations:_--- p -_ -------------- ----- -------------------------- �- "�- -------- ------- ------ °, . ,. -- _ �Q ---- ---�--=----- --.. ---------- -----_.. ............ .._- ..................... ........... . . .. ------------ ----- _ ------------- -- - ----------------------- -- FINAL INSPECTION 8Y:-1.-/ � _ .�L-I� ---------- --------- Date---- -.'._. __.lP. ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxalton Ave. 300 West Oak Street 124 Sycomore Street • 205 West 4th Street Stockton,California Lodi. Cafifornia Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press