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FOR OFFICE USE: Jw 7" S-117 --- ---------- ...---------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. __ . . _Q�� ------- ------------------------ -------- ------ ' _ (Comple+e-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 and 'install the work herein described. This application is made in compliance with County Ordinance No. 549. br JOB ADDRESS AND LOCATION.-.41 `/'' y---R ------kms-��)-w---- Q+�----4__4.�_Q.__�I Owner's Name--------_ -. ?�=r------Ln✓-o-M-t�S ----------•------------------------- ------ ------._ Phone.. ----------- Address....&7t-_---3-------&A-----11PY--------------------------------------------------- -- Contractor's Name---70�10v_,__ _e__0------- ----------------------------------------------- Phone_%3b__-)__'.1_174_ Installation will serve: Residence [A-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_- Number of bedrooms _Z_ Number of baths__.----- 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 [r Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_....... ) No ❑ New Construction: Yes P1 No ❑ FHA/VA: Yes ❑ No ❑. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is available within 200.feet.) r - Septic Tank: Distance from nearest well...�'Q___Distance from foundation--___ _a_._.._._ Material ------67ON-F'�&T13 ---_.. +� [ — No. of compartments_.__..l',JV47....__Size-----/A-e-A-----------Liquid depth----6A..... ........Capacity-_-_______-______.___ Disposal Field: Distance from nearest well...,`t•.�f-__._Distance from foundation__!9+t--_-__--Distance to nearest lot line----------------- ❑ Number of lines------L__A'Q_....._--------Length of each line__ ----/04_ ------------Width of trench____"_______________________ Type of filter material.__1_�s_____________Depth of filter material----,1 «.-_-_---Total/_0 __. length.......-0a'___________________._ -------Distance from foundation___ 0!-_ Dista`ce to nearest lot line _________________ Seepage Pit: Distance to nearest well__`_,'f`'0 11 Number of pits._. '�{l`1_.___Lining material.k!1A04L1_e Size: Diameter-___314_---- ----Dept h.....-S ___._ -------------- 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 - -- - -------- - ---------- ---------------------------------------------------------------------------------------------------------- 160 Remodeling and/or repairing (de tribe):eop' _" ----•-•----•------•-- 1 -- ?--- - .' ------------ -- . > ------- ----------•-------- ------- -----------------------------------------------•------------- ------------------------------------------------------------------------------------------------------------------------------------------------- I her certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinance ate la and r and ulations of the San Joaquin Local Health District. 5i ned .. 1? -------- ------- -------- ----Owner and/or Contractor 9 -[-Tine)-- _ W.✓ F 2 --- _ - - -- (Plot pan, 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 BY-- -.= _.,..___.. _ ----------- -------------------------------------- DATE--- ------------------------- REVIEWEDBY------- -------------- -_---------------------------------------------- ---- ------- ^------- --- ------------------ - ---- DATE-- ---------•--------------------------------------------- BUILDING PERMIT ISSUED-------- -- ------- ----------------- t -- DTE Alterations and/or recommendations:____..2 ! _ ...............---------------------•------------- ------- -------------------------------- ---------------------------------------------------------- ------•----- --------------------•---------------•--- - - --------- --------- -------------------------------- FINAL INSPECTION BY: -- - Date-----� .~ -----------_--_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:►Iton 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