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FOR OFFICE USE: ..........._______----------------------------. _ APPLICATION FOR SANITATION PERMIT Permit No. . .`3 .... ----------------------------- - ------------- -------- (Complete in Duplicate) Date Issued �_�__�_4_e _ ......... This Permit Expires i Year From Date Issued A..pplication 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 AND LOCATION_.-lr _?�,,Prl�/C/A/Id.I J/�.F�fJ�i�/_ � 'Ts.st' - " Owner's Name--'- -----.-- -----•---�--�------------ ---t-- ---- -- ----------- ---------- Phon Address__. 1114 o -- ---- ----- Contractor's Name-------- - ---------- "�- ------- ------- Phone ps� Installation will serve: Residence �Apartmen} House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living - ___ Number of bedrooms -3----units: _f -3___ Number of baths-- Lot size _____ __ _______ -------,---.-.----- Water Supply: Public system ❑ Community system ❑ Private A"Depth to Water Table/D- ft Character of soil to a depth of 3 fee+• Sand DGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ , Previous Application Made: (If yes,date------------------- ) No New Construction: Yes 9?--'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'i4 public sewer is availal5le wi+hin-200 feet:) - Septic Tank: . Distance from nearest well.5r Dist cue froom found ation_�f�_-_.. __Materia*��..�'a"7�CT ---------. No. of com artments_ P SizeOX Liquid depth. Capacity_fp0 f . Disposal Field: Distance from nearest well._p ....Distance from foundation- lei__-------Distance to nearest lot line Number of lines___1__-____________________Length of each line__ -___-__._-._._.Width of trench__ca2._{'�-_-_ ---------- Type of filter materi _ _. e< YP ��v�L----Depth of filter matenal__��--__._-.____Total length....�.�0_.- _�i__-_�-____-_--._ Seepage Pit: Distance to nearest well. - ------- ----------Distancfe from foundation-------------------Distance to nearest lot line----_-..--------- ❑ Number of pits--_' -------------Lining material---------------- --- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation ................ ..Lining material-------------------------------..__--. ❑ Size: Diameter- ------- ---- ---_----- --.Depth--.--.-------- - ---------------------------------Liquid Capacity------------------------_-gals. Privy: Distance from nearest well-------------------.....................---------Distance from nearest building------------------------------- ❑ Distance!to neares} lot line------------------- -- - ----------------------------------------------------------------------------------------- S Remodeling and/or r repairinr(describe) __-__..._ L --.----g gam I ------------------------------- ----------------- ------------------------------- -------- ; -----------------------------•--------- ------•-------------•---------- - ----- --- ------------ ------- --------- ---------------------•-•--------------------------------------------------------------------------------- --------------------------- - - I hereby certify that Ilhe a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ,State laws, and rules and',regulations of-fke San Joaquin Local Health District. (Signed) �/ /�� `I ed} , i y Ear .5-- -------- �:��-------- � rrd or Contractor) -�-� ._., /� 8Y=--- t --•4�-^ ---+- -- -- _>�--- ----------- -------- ------------- (Plot plan, showing size of lot, locations f system in �atiion to wells, Buildings, etc., can be placed on reverse side). F,OR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY_____.-. .__! f1-C� ----------------------:_ d -- DATE --Z -------------- ----------- REVIEWEDBY-------------------------- ---- ---------`---.._------------------- ----------------------------------------------- ------ DATE BUILDING PERMIT ISSUED.------- -- '------------------------------------------------------------------------- ----- DATE -------------------- Alterations and/or recommendations:- ------ -- -- -------------- ---- ---- -------------------------------------•---•- � t -------------------- -- •---- ----------------- - --------- ------ - ----------------------- - --------- -- ------------------------- ------------------------- I - -------- - ---------------------------------------- - --- ---------------- ----------------------- -- - -- - - -- . -- ..............- ----- . ------ --------------------- C - - FINAL INSPEC Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasallon Ave. .t 300 West Oak Street 124 Sycamore Street 1 205 West 9th Street Stockton,California Lodi. California Manteca,California y, Tracy,California E.H.9 2M 1.67 Vanguard press s: