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FOR OFFICE USE: ------------------ '-W ------------------- rte,__ _ APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) n ' - 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 instal4Phon - Address rein described. This application is made in compliance wifh Cou ty O finance No. 549. 5:7 JOB ADDRESS A LOCATION Jl.a ...-'-' W t7 '- '--+------- ----- -- - ------ Owner's Name. -_- _ - ----- --_---- ------- ----- ------------------_--- ,4 -----------------_-- Contractor's Name 'Q - '""r ---"` ------------------------------ Phone. RP-�P � ------ Installatiori will serve- Residenc`e3"A—Ap rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other f] Number of living units: _/----- Number of bedrooms Z-__ Number of baths __1-___ Lot size &C. ------- -------- ---------------- Water Supply: Public system r—Se Community system ❑ Private ❑ Depth to Water Table 7--';---ft t Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeX Hardpan [] Previous Application Made: {If yes,date-------------- I N0 New Construction: Yes ❑ No F"/VA: Yes ❑ No)j� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well.................Distance from foundation---------.---------Material ....-_-.---------------------.__--_---..-..___.. ❑&%(0`f t0(;No. of compartments--------------------------Size.�-------------------------Liquid depth.- ------- ------- Capacity----------------------- Disposal Field: Distance from nearest Distance from foundation-1-5----_--_._.Distance to nearest lot_ french line__ _----- G4 Number of lines -`-'_Q- r_CP. ___ ____Length of each line_AP"_K,__.,5.�._.._.Width of trench-__.Z4 eJ -------- f� �., ` o -v Type of filter materia)_ 'Z .__-Depth of filter material-______________________Total length-.-..--....__,_-._--._._____________-__--- 0 Seepage Pit: Distance to nearest welf_ Qi '.--Distance om f undation__Xr0---- -_-Distance to nearest lot line_-_��_--.-_-..- Number of pits.. _ _ _ - - _Lining material__ .. Size: Diameter__3.3.............Depth_._.`).__$ Cesspool: Distance from nearest we}i ----------------Distance from foundation_............... ..Lining material ________-___----__._-.-_-._-__----- ❑ Size: Diameter- ]----1--------- •---------------Depth------ -------- ------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---_.........................__.-------__--.--.Distance from nearest building----------------- ❑ Distance to nearest lot line ' ' --------------------------------------- ------PA--------_1 ` ---- ------- -------- ' - -------------- ----- ------- Remodeling and/or repairing (describe): ------- '- ' ' ' c.�!'___-------- -- ------ ---- --------- --- --------------------- ----------------------------------------------------------- - ----•--------------------------------------------------------------------------------------- I I - '- ------------- ----------------------------••------•-----------------------------•---------------------------'--------•---------------------------- ----------------------------------------------------------- I hereby certify that I hav prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ul and regulations o he San Joaquincal Health District. t ( o (Signed)•------------------------- f- -------- - I ---- ------------------- --------- --------- -- ' -- ---(Owner and/or Contractor) By:_------------------- /r - (Title)----- _%-------- - (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be plat on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__-____r ..i------.-__ '0"" ------ - ---- - --- -- --------------------- ---------- DATE--'--��=-�`�y�---------'- ----------' - REVIEWED BY- '-------------- --- --' DATE -- ' BUILDING PERMIT ISSUED I' ' ------ - _--;; ----------- ------ -- DATE---------------- Alterations ----------- • --- Alterations and/or recommendations: _ .: . ____ a.v�c I - ---- - -- ------- ------------------------------ ' ---'- ......----- -.---------------------------------- ..-------- . p 62 FINAL FINAL INSPECTION BY: _ Date -- ------------------------ ------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave: 300 Woof Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californiar Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Prasi