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FOR OFFICE USE; -------------- -- --------------- ----------------.._- _ APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ----- -- - ----- -- " (Complete-in Duplicate) Date issued ._--._------------------------ --_-. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin local Health District for a permit to construct-p0-install the work herein described. This application is made in complian with County Ordinance No. 549. f X1 � iRl-o1\(, JOB ADDRESS AND LOCATI --- -- V� 7 is JT -�._ __. �-------- --- -- , i --------- Owner's Name-------------- �_ l-1 ------- Cr_�_RS.T� _ l.�i ------------- ---------- ------- --------- Phone-- �4o-7731.--- Address--------------- __ --------- ----------�o-x--------f0-4-7----------------------- c ,----------- ............. cc 4 cam:-o6 R`r_� - Contractor's Name..... v.uN E ---- - ------------- ---------------------------------- ------- ----------------------------------------------- Phone------------------------..--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: - ,---- Number of bedrooms Zr Number of baths j_._ Lot size --. - - —------------------------ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table --- _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan l� Previous Application Made: {If yes,date_---------- ---- ) No Kl` New Construction: Yes ❑ No ;�i�FHA/VA: Yes ❑ No TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_-_-___-.--.---Distance from foundation------------------- Materia! -----------------.---------.------_------_-----. V_X151146 No. of compartments--------------- --- --Size-------------------- -----------Liquid depth--------- ------ ------- Capacity----------------------- Disposal Field: Distance from nearest well__ 570---Distance from foundation---tom..__-.--.Distance to nearest lot line-----5_____-_- XEM&f(-I-- Number of lines ---------- ...............Length of each line._ .--.--��--ftp___...Width of trench ""I------------- 4— ADD- Type of filter material--- C-fes_.__Depth of filter material----._1�-._ g ------.Total length ----��--------------- Seepage - --------- Seepage Pit. Distance to nearest well-_-./ ----_Distance from foundation---h_........ istanc to nearest lot line__..--.----._ T Number of its..- --/---------------Linin material./MCK...._ Size: Diameter._ .__ __-._.�._y p g X 1�..---Depth--------f.-�'�------------------ � 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 nearest lot line __------------------------------------------------------------------------------------------------------------------------------------- A Remodeling and/or repairing (describe):-------------------- - - ------- ----- -------------------------------------------------- ----------------------------•--- ----------- -- -- ---------------------------------------------------------- --------------------- -------------------------------------------------------------------------------------------------- ------------------------------------------ --------------- --- ---------------------------------- -----------•----- ------- ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- -----•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aw nd rules and regulations of the San Joaquin Local Health District. (Signed)---�------------- -== --= :.- - -- - --------_-_ --------------.----- -- --- ---- ------.,(.Owner and/or Contractor)— By;-------------------------------- ontractor-)—By;-------------------------------- ----------------------------------------------------- --- ----------------------- ----- ------(Title)-- ------ - ----- -. -- - - ---------------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - ---------- -- ------- ------ DATE------ --- 7 T 7'-------------- REVIEWEDBY--------------------------------------------- _--------------------------------------- -------------------------------------- DATE--------------- --------------------------- -------------- BUILDING PERMIT ISSUED-------- -------------------------------------- ------------------------------------------------------ DATE---------------------- --- Alterations and/or recommendations:----- ------ - ------ -- ...... ---- -- - ------ ------------------------------------------ ---------------------- ------------- ----------------- ----------------------------------------- ------------------ -------------------------- -------- ----- ----- ---------- -----------------------------------------------------.---- ----------------------------------------------- ------------------------------------------------------------ ----------------------------------- ----------------------------------------------- ----------------------------------------------- ----- - ------------------------ - ................. -------------------------------------- ----------- ---- ---------------------------- FINAL iINSP ON BY:. Date............."._Z-_ 7 -. ? -_- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma: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