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FOR OFFICE USE: 013 0 ------------------------------------ ----------------- �7 ----------- --------------_-...-_ APPLICATION FOR SANITATION PERMIT Permit No. _.sz4. ....�.._ 71 ---------------------- (Complete-in Duplicate) 4�1 y -__-_ - -- .-- 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION--- ._._ - �'fJ � ---u- Y- Owner's Name-."- -- - ---- ---- ---- ------ ------ ----- Phone------------------------------------ �7 ....................... Contractor's Name--- t.f:-4---- — --- ------ -- ------------ -- ------- -- -------------------------------------------- Phone................................... Installation will serve: Residence ff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ? umber of baths I____ Lot size _.. ... ... .... . ..... .... �._-.------------------- Water _-_- _---..._-__Water Supply: Public.system-2-.Community-.system-E)—Priva te- -to-Wafer Table ft- ----� ----^�-T"" Character of soil to a depth of 3 feet- Sand ❑,NGravel � Sa?dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Er- Previous Applicatio.n.Made:.-(If.yes,da.te.- ❑.New Construction:-Ye s-E--No-B—FHA/VA:�Yes ❑ No-E]- --J- S TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic nk: Distance from nearest well--- from fountlat.ion-__---1�._......Material - --------------------------------------r Number Ii .Gr et No. of compartments__-___' �_..-.__._Size-_,-t l�S' _Liquid depth_*--_ _ ..-- Capacity'-T; 0, dDisposal field: Distance from nearest well__ _Q'0_�___Distancefrom foundation.__j!?__*----.-.Distance to nearest lot lineS__----of lines-------- ........... .............Length of each'.line� J-100!.._......._.Width of trench_. _'-�__.._�--______ Type of filter material---___-_.s`R_'___..Depth of filter material.___.-!_ _-`- ..Total length_-._1-�--�.�..._...--�_---_._----_ 'v v 11 See pa Pit: Distance to nearest well.-._�_OD---t-----Distance'!from,foundetion_-k-O.E__.._...Distance to nearest lot line_- ------------- Number .- -._..- d Number of its... ..._ --------Lining material___.___-$'_/_ Size. Diameter__ "� 44--- "'�------------- p �. t g� _.... - --- - -��------ Depth------. - Cesspool: ADistance from nearest well _--_._��':Distarice from foundation______________-(.Lining material--------------------- Size: Diameter- -- --------- ----- ----------------De th------.----------------------..- /----...Liquid Ca acit -'''r'' gals. Privy: Distance from nearest wel!---- ...................... .--------------------Distance from nearest building-------------------------- Distance _-.--_.______- _____wDistance to nearest lot line....._._ ------------ Remodeling and/or repairing (describe):-----4 ,- f.. �F ---------------- -----------•-------- -------- ---------------- --_-------------�------------- -------------------------------------------••------------------ ------ ------------- ------------------------ --------------------------------------------------------------------------------------------------------------`- -- ----- --------------------------- r ---------------------- ------------- -------------------- -------------------------------------------------- ---------------------------------------------------------------------------------------- --- ---- I hereby certify that I have prepared this application and that-the w6ek.will be done in accordance with San_Jo#quin County ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. i (Signed) .r3y.. - --�_-------j`-. nd/or' Contractor) By. -------- ---- --- -------- --- -------------------s.;_{Title)......... -------..---------------... .. (Plot plan, showing size of lot, location of system in relation a wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.-- .... ......... ---•----------------- DATE-- REVIEWED ATE-REVIEWED BY----- ----------- - ----------------------------------------------•-------------------- DATE------------- - --------------------------- ---------------- BUILDING PERMIT ISSUED---------- ----- ------------------------------------------------- - -----I——---------------------- DATE - - ,Alterations and/or recommendations:__ -------_._- - - --- -.............. -------------------------------- ---------•- ----------------------------•------------------------------- ------....-- --------- ----------- -------- -------- ----- --------------------------------- ------------------ ------------ ---------------------•-------- ------------------------------------ ---------- ----------------------•- -----—-, yr FINAL INSPECTION BY: - - � .--------- I}ate_ _�Lr SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon 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 r