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FOR OFFICE USE; r 91.1 - .-......._.._.___-_.-...__________-......__..__.... � APPLICATION FOR SANITATION PERMIT Permit No. -----:------ ... (Cognplete•in Duplicate) ----- ----- ------------------------ - 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 co sfru t and install the work er 'n de ribed. This application is made in compliance with County Ordinance No. 549. ��GC tJOB ADDRESS AND LOC TION---I--------- fr 7 ...__. ' ` ..- --------------------------------------------------------- Owner's c y /rte,,/ ` �7�,//9F_ - �!"►� � ---------------- ---------- Phone Address - i� -1 #WE ----C-------- Contracto ' Name-------�,�•�`---------- -------------------------- ----- ------- ------------------ ----------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms 3--- Number of baths_* Lot size -----+ rlt-Gt�l ----- --------------_---.-- Water Supply: Public system ❑ Community system ❑ Private ErDepth to Water Table .0 it Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay T--Adobe ❑ Hardpan [] I .. Previous Application Made: (If yes,date................_. I No New Construction. Yes- E?"No ❑ FHA/VA: Yes ?T`No ❑ l -'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.- ........Materil _ lt+� f/1, --------------- , � P Z--------- Size' fel._. K_7---Liquid depth-_ - ` ... . ----...-Capacit «--G® �• No. of cam artments...___ y Disposal Fie3d: Distance from nearest well..SS.T___-- Distance from foundafion.1l0--------------Distance to nearest lot line-1. ----------- Number _--.-...- Number of lines.1-.-._ v �-----------------------Length of each line._e�Q. .---°---------..Width of trench----f�4...__-_----.-.___ --- 5 + Type of filter material... at ___--Depth of filter material----/_$'...`._.......Total length----10K--w-.____-...-._ _ Seepage Pit: ✓ Distance to nearest wel1..� 6..�_ .__-Distance from foundation_-- ..r...-_...Distance to nearest lot line---- .... Number of pits._I ----_-__.._.--Lining materiaE...2aC-��----- Size: Diameter�(.�-k------ Dept h....12, 4------..__-.-...- I i x Cesspool: Distance from nearest welt ----------------Distance from foundation- ......... _Lining material.__...-.___--_-._.................._. ❑ Size: Diameter- -- -------._ ----- --------- Depth--------------- -- ------------------ ------------- Liquid Capacity---------------------•--•---gals. Privy,'A Distance from nearest well----------------- - ------ Distance from nearest building------------------------------ ------------ Distance -..--_--_-_---....._--_--..___ - -------Distance to nearest lot line--------------- - - ------------------------------------------------- -Remodeling ----------- ----------------------------------- -Remodeling and/or repairing (describe):-------------- ------- ----- ------------------------------------------------------------------------ -------- ---------------- --------------------- ---- --------------------------------------------------------------- ----------------------------------------------------- ---------------------------------------- _----------------------------------------------------------I r I Hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawi, and rules and regulations of the San Joaquin Local Health District. (Signed) - _ ^ --(Owner and/or Contractor) By._•------------------------------•----- ----------------------- ----------------------- -------- ------------------------------(Title)----------------- -...-- ..-- ..--- ....... --- ------ - (Plot plan, showing size of lot, locatiot n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ )Itw _ � --------------- Z..... REVIEWED BY----- -------------- ----------------- DATE: ------ BUILDING PERMIT ISSUED ---------- ------------ ---- ------------------ ----- DATE----- - Alterations and/or recommendations:I- ---- - ----------------------------------- -------- ------- ' 1. -c� ._..... . . 1D_I�U-------------------------------- 4 ;. - D r { --------------------------- ------------ ----------- " — ot --------- --------- --------- ------ ...... -- -- --- - 00, ------ -- --- • I FINAL INSPEC ------ Date------- ------ -4 --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton 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