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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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. o JOB ADDRESS AND LOCATION. Owner's Name.- -------- D-1.�--/__Y___.1.._2_6!__!___ ------ -- --------------------------------- Phone- /✓- .__. �f{ Address ........ ----••--•- 1----------- ------ - ---------------- Contractor's Name------------------------�---- •---��-?�.�..c. - --- - �------�� -- - -��--�'--�-��------�---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j---- Number of bedrooms _ _.. Number of baths I____ Lot size __ _____ ___ ___ --- _ ..__._.__.______ Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table/p ft Character of soil to a depth of 3 feet- Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam,, Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.....__.--------- . J No X New Construction: Yes ❑ No X FHA%VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well,/ ��__... Distance from foundation__9.0-_._____.Material _ __. _."____..._.._"_ _.....__ No. of:compartments�� ._.. -----------___."__._Size__ �O( .___Liquid depth"�_2_--- --------Capacity... _-___ Disposal Field: Distance from nearest wellfav_.__Distance from foundation__ 7_ti _"".._....Distance to nearest lot line___ Number of lines.--_ -�------------- --------Length, of each line_- ----------------------_....Width of trench--------------------- - ------------ `i• Type of filter material-------------------------Depth tof filter material-----------------------Total length--------------------------- ---------- ----- i i Seepage Pit: Distance to Weare/�t "ell_ �JQ_.......Distanc rom f ndation__Z_�----------Distance to nearest t lisle_��___.._ Number of pits__L. "/. - Lining material-. Size: Diameter.. Depth ------ ---------- T' / Al Cesspool: •` Distance from nearest well ----------------Distance from foundation-----.----------- ..Lining material-_-.---- ----------.--_________...__El (� Size: Diameter=- -- -------------- De th---------------- -------- - - --------Liquid Capacity ---- gals. Privy: Distance from nearest well--'--:- --______ _________________________Distance from nearest building--------------------------------- -------- Distance to nearest lot hp-e-. ----- . - e - •------------------------------—------------ ----- ---- ------------- . C.1 Remodeling and/or repairing (describe):----.-. -- -- -- -- - --- -------- --- -- -- ------- ----- ---- - _ -- _ _ ---.-----__-- =q_)6 - Ct-- - -. Q_ �-------- -- r }_ -', I hereby certify #haul ave prep ed this applicatibn and that the work ill be done in accordance with San Joaquin County ordinances, State laws, and rule and rejulations the San'Joaquin Local ealth District. r (Signed)--------------- ------------- - --- -.__,. _ (Owrfer and/or Contractor) �• i �� BY:----------------- --- 4}.---(�_-... ------------- -- -----------�-� _(Title) .--- - --------- (Plot plan, showings a of lot, location of system in elation to wells, bui ings, etc., can be pla d on reverse side). ` FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY-------1 _--.Vk--.............. ------------- - REVIEWED BY--------1--------------------- ---- ------------ 3----------- ----------------=--------------- DATE BUILDING PERMIT ISSUED-------- -- - ---- ------- ----- - -------------- DATE ------ Alter +ions and/or recommendations:_ _ `--- _ w _ --.-" -- - --- - -------- --- - '�""'Fitt ------------------------- ' {�. t o I &--ie---- ------------ - - -" --- ------------------------- --- ------ ----- --------------------------`................... - - FINAL INSPECTION BY:------- --- - ------- ----------- Date_ /-_6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeiton 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