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i FOR OFFICE USE; 's c --- --------'----------------- ....... # ---------------------------------------- --------- - APPLICATION FOR SANITATION PERMIT Permit No. _O S� --------------------------------------------- ----' (Complete-in Duplicate) __......___. -- -_----- -._._ This Permit Expires 1 Year From Date Issued Date Issued _jQ /._.._.. 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. 1 JOB ADDRESS AND �LfOCATION----sr.� �j� THIZ Owner's Name------------17-�- _R/Y---------r! X0_.1"-�-�FRR� ' ---- ---------------------------------------- ------------ Phone------------------------------------ Address__.. �1� = 5 f- _ ------------------•• ��Tl .__........ S . Contractors ---••- -- --- ---' ---- -- ---------- ------ -'-- ---- - - --------- --- Phone--- ------- hone .- . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -. --__-Number of bedrooms Z_—_ Number of baths I------- Lot size ---lalOdQ_._ ------ ------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table L - ft 1 ( � Character of soil to a depth of 3 feet- Sand (Grave! ❑ San y-Loam ❑ Clay Loam ay ❑ Adobe ❑ Hardpan ❑ t11 I' Previous Application Made: (If yes,date................... I No New Construction: Yes No ❑ FHA/VA: Yes ❑ No Q� _TYPE OF F INSTALLATION AND SPECIFICATIONS: :. '(No septic tank-or cesspool permitted if publics wer is available within 200 feet.) Septic Tank: Distance from nearest well_c_-___---_--Distance from foundation-----I�J_.......Materialek!6.C{ti�T� -V C No. of compartments--_-_2.. ...........Size-SXIZ .._. Liquid depth__-- � � - pa city..__ _ Disposal Field: Distance from nearest well__ ,L :_Distance from foundation---_---------------•Distance to nearest lot ` line----------------- F—YXl !f J( Number of lines_________/_-__ ______________Length of each line__ ___ __. ..-_._.Width of french---_---2lk -.- �+ _ Type of filter material___ _ �� __-._Depth of filter material.- -_--`._._:_..Total length______.____, ,� Seepage Pit: Distance to nearest well--------_---___-------Distance from foundation----------------- 'Distance to nearest lot line---- ------- ___ ❑ Number of pits.----------- --------Lining material----------------- .... Size: Diameter------------------------Depth--------------------------------- 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--------------------------' - Remodeling and/or repairing (describe):--------TJ6l4T._.__4-)_LJ�----- QT---_JN I' TE[�_--------'-'----- - - ------------------ ---------------------------------------------------------- ---•-------------_- .-----•-----------------------•-------------- r ---------------------------------------------- -- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ( ordinance ate laws, and rule and regulations of the San Joaquin Local Health District.. (Sign - - ------------ Contractor)-.__ wner and/or y:-------•------- --------------- ---------------• --------------------- ---- ---- - ----• -- ---------------(Titli)---- --------- ------ - .......... — -' (Piot 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 BY--------" .t _�___---.-....._ / --------------------------- -----'------ ----------------- - --- --'-'--------- DATE_-'---- %�..,- ------ - ' REVIEWED BY --------- - ---` -----. DATE_ - -- ---------------------- rBUILDING PERMIT ISSUED-------- -------------------------------------------- ---------- ---------------------------------- DATE--------------------------- --------------- Alterations and/or recommendations:--------------' ----------- ----------- --------------------------------------------- ------------ ------------------------------------------ ' ------------------------------------------- :_------- ------ -------------------------------------- ----------------------------- ------- ---'----•• • -'-------'----- ---------- ------ - ---- --- ---------- ---- -- ----- --- -------- --------------------------------------------- --------- - - --------- -- -----------------••--- r -------------------------- ----------- ' --------- ---- ---" - --------•-------------- - - ------- ------------• --- ------- -- ----------------------- -------- ----------------- ' FINAL INSPECT�N BY: ---- - ---- '�— Date......- {Q r ' ...47 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave, 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguerd Press