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FOR OFFICE USE: _ '- �----------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. .,: at;�3 (Complete•in Duplicate} - ----- ------ - ---- --------------- - -------- h _Date Issued __________________ ------------------ _--- -- -- This Permit Expires 1 Year From Date.lssued Application is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein described. I This applicatio/n.i`s made in compliance with'County Ordinance No. 549. JOB AbbR>=SSA L .CATION_.,_ _' ._ j- *- ------W ---- 'r ------------- t.,a..-� i _. I Owner's;.Name----- - / -- --- 1 ,�€-F AlPhone , _/'" - 73 Address---------------------J--�- ----1-------f-' _ ----- -110- a ": ----------•--51.04 ?vA� ---------------•----•*-------------------- -------. Phone�f& !3:f A . .. Contractor's Name_-•sN--- �-• =�e-- -�-�-----'---�-------- -i!�.�--- --'------------------------'------ ---- •- �-- - =- ' /Installation will serve: Residence KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms - ,___ Number of baths. Lot size -- .r-------------------- Water Supply: Public system ❑ Community system [:1 Private K Depth to Water Table 787t Character of soil to a depth of 3 feet- Sand E] Gravel ❑ Sandy Loam I-] Clay Loam ❑ Clay ❑ Adobe IRK, Hardpan F-1 Previous Application Made: (If yes,date_- -,------------ - ) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sever is available within 200 feet.) i Septic Tank: Distance from nearest well-- -pistance from found •ion_- _r-- _-. ____ _._....._.___. f -..---- .Material.------ --- ---- -1"E No. of compartments-- (7---------Size-1100-Size -1_. Liquid dep�h_ !-71.i...__._..Capacity-_�_ " If f Disposal Field: Distance from nearest welL+ :10l0__.Distance from foundation---. ®..-....Distance to nearest lot line,-2a -- -------- Number of lines.-: -1--------- --- Length of each line__._ ..-.-_-.I Width of trench___., t E4------------------ I Type of filter material-R. C-------------Depth of filter material---- ------ - Total length-_-_LM- --!. -------------------- -- - 1 Seepage Pit: Distance to nearest well_, _-.-_-Distance AV6U. dation__/ ' ____Dis ave to nearest lot Number of pits__. .-._-Luling material---- Size: Diameter-_.- ..----------Depth----,e -------------------- Cesspool: Distance from nearest well --------- ------Distance from foundation .___------ _lining material---------------------------.-__---.-�4 ❑ Size: Diameter- -- -------------- ----------------Depth------- --------------------- ------------------ ---Liquid Capacity-------------- -------------gals. ` Privy: Distance from nearest well__________ ____________________________________Distance from nearest building------------------------------------------ Distance -----__.--.._ .-.Distance to nearest lot line - -------------- ------------ -------------------- ------------------------------------ ------------------ Remodeling and/or repairing (des cribe: ' = ter , ----------------•-•------------------------•-•---------•------------------------------ --------- -- •---------------------------------- I hereby certify thehnrepared this applicationand that the work will be done in accordance with San Joaquin County ordinances, State laws, nd regulations of the San Joaquin Local Health District.,.(Signed)------------------------ .- ------..��. .-- - --- -'- --- -- --_� ,< ---- - - (Owner and/of'Contractor) By:------------------ ----- �- ----- .....(Title)---------- �reerie -- -------- ------- --------- (Plot plan, showing size of lotlocation of system in relation to ells, buildings, etc., can be placed de). '# r FOR.DEPARTMENT USE ONLY - . APPLICATION ACCEPTED BY-------.____ - __________________________ DATE_..__ REVIEWEDBY--------------------------------------------- ----' -------------------------- -------- -------------------------------------- DATE------------------------------- BUILDING ----------BUILDING PERMIT ISSUED.------- -- ------ DATE---------------------------------- Alterations and/or --______________---.---__-__.__---_____ ----------------------------- ------------- -_ . ._ --•------•--•---- --- -- --- ---------------------------- ------------- -------------------------- ---------------- --------------••-- •------- --•------ • -•--- FINAL INSPECTION' BY:----- '' --------:- Date---- - ` ---------- �. _. _ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Ha:ellon 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