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FOR OFFICE USE: ---------------------------------------------_---_____ ,APPLICATION FOR SANITATION PERMIT Permit No. -- �- ----------------- --------------------- (Complete-in Duplicate) 7 ------------ 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 with County Ordinance No. 549: �}- JOB ADDRESS AND LOCATION__. .t-------------------------------------!_v_!_l _N_TC --------------- Owner's Name--------- � ,v L- ��FQ�� -- -- ---------_----------------------- -----------._ Phone-------- -----------•---••----•-••-- Address___________ __ Contractor's Name-----I- vt4 i:5!.�"'s._ :l�`I-]�-------�>�R t c�----- ----------------------------------------------- Phone------ -------------_------------ Installation will serve: Residence l�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Q [-_—_ , Number of living units: __ �_._ Number of bedrooms umber of baths 1------ Lot size ___ ________________:__-_ Water Supply: Public system ❑ Community system Private © Depth to Water Table _ ft 'PrevCharacter of soil to a depth of 3 feet. Sand Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan E:]'- Previous ious Application Made: (if yes,date--......... J No 53`�New Construction: Yes ❑ No ©e--FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPEOIFIGATI0INS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i V� Septic Tank: Distance from nearest well_________________Distance from foundation------------------.Material ___._.____.___.._..____.__._______.___________. C[ -rI NG No. of compartments - Size Liquid depth----;----` Capacity }_ 1 k�i _ Disposal Field: Distance from nearest well...50----D�stance' from foundation____f_ _______.Distance to nearest lot ------------ F�[[]s'�NG Number of lines---------,`_ __----------------Length'of each lire_.-_x`3_.0----`_--�.._.{.Width of trench-_ 2'- _1- -----------� Type of filter material._.RO.t4_..._Depth of filter material____..1_1__i._.___.__Total length______________ ___.___--_.__ Seepage Pit: DiOante to nearest well._.__._-_____________Distance from foundation,.,__-------------.Distance to nearest lot line-----___--------- Number _____.._Num er of pits--- ------------------Lorin material.----=�•.__-�_._____.. Size:•Diameter:-n--::--'--._._...-.-Depth----------.------------- Cesspool: Distance from nearest well ----------------Distanr,e from foundation......----------- _.Lining material_-.----------------- ---------- ❑ Size: Diameter- -- -"_----------- _ ----------------Depth---•--- -- - ----------------------------- -------Liquid Capacity------ ------- -----------..gals. Privy: Distance from nearest well______ ______ �_ _.__-._._.._._.Distance from nearest building._________ __ ____ _---. i ❑ -- Distance to nearest lot line - --- ----- --- -------- - - ---------------- - -------------------------------- - Remodeling and%or repairing (describe):---------------------- -------- - - - - ------------------------------------- ---------------•----------- ' ------------- r- ------------------ : - ::__. - _ -------------- ------------•- ---------------•---- ------ ------------------------ ---------------------------- + Y Y prepared AP q - yJ + I hereby certify that l have re ared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s,land rules and a let ns oft a San Joa uin Local-Health District. (Signed) ---- - I ----------- t-- ------- --------------------------------------- -- �-�o-._,�:.�(Owner and/orContractor) _ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). { i ' FOR DEPARTMENT USE ONLY I ter^ APPLICATION ACCEPTED BY._.._.-.-J--i.R-' �---------------------- ----- ------ DATE_...... l- ' :...- REVIEWEDBY------------------------- ----------------------------------------------------------- -------------------------------- ---- DATE------------- --------------------------------------------- BUILDING PERMIT ISSUED---------- ----------- ------------------------------ -------------- --------------------- DATE - Alterations and/or recommendations---------- - - ---- ---------------------- --- -----------'--------------------------------- --------- - ----------------------------------------------------------------- ------------------- -- = f _.. )� _______________________-------------_---------------- .__._....__. _. __._-...___..__.--------------------------------...__--_- ..______..--------- ---------- .____..---._.__._.._.___._____._..._... - j ------------------------- --- FINAL INSPECTIC Bl�. = -- r ✓ Date------- ----- " `? . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,canfornia P.H.9 2M 1.67 Vanguard Press