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FOR OFFICE USE: ---------------- ----------- -- --- --------------- s. ------------ APPLICATION FOR SANITATION PERMIT Permit No. _8�-1 _S -_-- (Complete-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 construct and install the work herein described. This application is made in compliance JJwith //County Ordinance No. 549. JOB ADDRESS AIN__.LQCATION____ -------------- !_ - Owner's NameQ�L'_� I / {.. - Y�P�/s� -- Phone-------------------•--- Address------------------------------------------ � ---y7-------- ------ --------------- -------•------. --•------------ Contractor's Name------ --•------------r! "------ % Phone.. Installation will serve: Residence KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ----- Number of bedrooms` Number of baths....)`__ Lot size _ � --j _____________________ Water Supply: Public system U--C70system ❑ Private [] Depth to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl y ❑ Adobe ardpan ❑ Previous Application Made: {If yes,date_------------------•)•.No New Construction: Yes Flo ❑ FHA/VA: Yes ❑ No [4--- TYPE rTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n ---- ____1 ---------- Septic " +O T �c Distance from nearest well-----"-- from foun tion___ _ ! __.Mat riaf _ _ ! �� [ No. of compartments-----.�-_-----.----Size_-,�.�__�3x --Liquid de ph_---��.------- Capacity_--� /----- Disposal field: Distance from near t,weil_- Distance from foundation.-l40-----.-._.Distance to nearest lot line_.. _____.__ Number of lines . /- Length of each line__ ----- �/__ ..........Width of trench-_ - Type of filter material / �- __Depth of filter material_ / __ Total length-- �___ /__-._ t9 r See pa /Pif: Distance to nearest w IL ............Distance f fo ndation____��_�__ Distance to nearest lot aline-- ---__._.-- [ Number of pits__ ._ _.._._._.Lining material-_ .0 Size: Diameter -Depth .o ._, -___-.-. 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)----------- --- - - -------- ---- :_ a-------------------------- ------------------ --------------- -- ------------- -----•------•-• ----- - - ----------- /-- ------ 'r' lrr- 71"r �+�1 -. �t _ �� l�l1Cl ------/ 6,1� -------------------- ris -- -------------------------------------------------------------------------------------------- 51I hereby certify that I have prepared application and thaf the work will be done in accordance with San Joaquin County ordinances, Stat s, and rul regulations Th San Joaq`u' Local Health District. (Signed)--------- --:- - - ---- (Owner and/or ontractor By:---------------------- --- ---- - F - - ------------ -------- ---------------------- --------(Title) (Plot plan, showing ' of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �. F EPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------ ------------------------- ----- DATE- REVIEWEDBY----- ------------------------ --- ------ - -- ----- - -------7---------------------- ----------- -- ----- ------ DATE------------------------------- BUILDING PERMIT ISSUED------- -- - ---- - --- ------------ --------- ---- -- ------ DATE---- -------------------------------------------------------- Alterations and/or recommendations--------------/�� r t---U---�--- -------•--------------------------------`�'I _ -------------------------------- --------------------- --------------------------------------------- --------------------------------------- ----- -------------------- --•---- -------------------------------------------- -------------------------------------------------------- ------------------ -------------- ------------------------------------------------ -------------------------------- ------ -- -.-- - -------------------------- FINAL INSPECTION BY:.. t - ----- lr Date--------- '� .�' �/ -------- SAN JOA UIN LOCAL HEALTH--DISTRICT 1601 E.Hoze ton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.92M 1.67 Vanguard Press