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FOR OFFICE USE: I�oo I ma P� t� --------------------------------------------------------- J ) :_._-_-_______-_________.-____-_-_____._._.__.-- - APPLICATION FOR SANITATION PERMIT Permit No. ._ ....1�..( 01. -- ----------------------- ----------------- (Complete-in Duplicate) ' • r�r __ - --_ -------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _______________ / Application is hereby made to the San Joaquin Local Health District fora permit to construct and in all the-York work herein described. This application is made in compliance with C unt/Ordinance No. 549. / k3o&e /s L, JOB ADDRESS AND LOC TIO 7i _ ----- . _l Owner's Name ---- -- ----- - --------------- -------------...----------- -----------y---------- hone............................... Address� .L.r�1_.�. ------••----------------------�--+-.--•------. Contractor's Name--- ----- ` - ------- •--•-_---------------- Phone.�L1?V4$7A..... Intiaallation will serve: Residence J$j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] -Other [] Number -/-- ,!-_ tiof living units: _!-_-- Number of bedrooms --_ Number of baths_�._ Lot size _��.,t� O' ..... ................ . Water Supply: Public sysfe ;' ommunity system ❑ Private ❑ Depth to Water Table --___ - ft Character of soil to a depth of 3 feet- Sand Q Gravel ❑ Sandy Loam F] Clay Loam V Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date---------------- No ❑ New Construction: Yes E] No E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.---------------Distance from foundation-------------------Material __..-.--__--.-_--.-.-_.-_.--__._---.-.--_------. ❑ No. of compartments------------------------Size-------------------------------Liquid depth.-------- ------ ------- Capacity-------------------- - Disposal Field: Distance from nearest well__<I�.. . Distance from foundation... .l1 --------Distance to nearest lot line.......... � Number of lines....... ......... ..... Length of each line_-___ _ __ . Width of trench. 0 Type of filter material_ - __Depth of filter material-___------------.Total length..... ..............._-___.___---_--- OL 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------ ---- ----------------------- - is}uid Capacity- ----- ----------gals. Privy: Distance from nearest well.... ._._-_-___.__._-._______Distance from nearest building____________________•-.--_-__-._------.-. c ❑ Distance to nearest lot line - - ---------------------------------- 1 _ ---------- ------- a Remodeling and/or repairing (describe):.___ °Ze.0._ x.._.__ ............. ------------------•------------••---------------------• ` . ----------------------------------------------------------------------------------------------------- ----- c - -----------•------ -._------•--------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rules and regulations of the San Joaquin Local Health District. t� (Signed) -- .: --- - ------------------------ ---------(Owner and/or Contractor By:--- ---- ------------------------ -------------(Title)----- - ------ -------- --- _ --- --------- ---- (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY- -- ---------------------------------------- -------------------------- DATE----- REVIEWED BY --- - --- -------- ------------------------------------------------------------ DATE----- ----=--------�---'--S�- D BUILDING PERMIT ISSUE '-- ------ -------------------------- - -------------------------------- Alterations and/or recommendations:----------- ----- -------_---------------------- ------------•-------------------------------- ------- ---------------------------------------------------- ----- ------------------------------------------------------------------------------------- ------------------------------------------- ------------------------- ---------------------_--- ------ -------------------------------_----- -._-___--._-..---...__.._-_-.-.----._-...._-____._______._--.._-_______.-Y______________-._______._..__..__.______._._-___-.._-._.__.__.__..,____.___.-___-.----._--_-._____---__-.----- ..__...•--•----------------•--------'-'-----"..._.._..........-..--------------------------------------------:• -•-------------'-------------'--------------------------------• -----------'-__.-,-----_-.-------------'--_-.- - --- .----- N FINAL INSPECTION B .--. .. . ....... --•- -. Date----- -----------��'�_%. - c 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 Yracy,California E.H.9 2M 1.67 Vanguard Press