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FOR OFFICE USE: 1' �Y --------------* --------------------------------- APPLICATION .FOR SANITATION PERMIT Permit No. _7 _ d ------------------------- --- --- ------- (Complete-in Duplicate) D - - - ------------------ _ This Permit Expires 1 Year From Date Issued Date Issued -------- --- -- --- -------------- - - .2t�— �f0�ffl Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein C69cribed. _ !�is ap.plication.,is,.made_in..com.pliance with County Ordinance No. 549. JOB ADDRESS A L CATION_ 1 -'---_ - = . -- .. ...... -------/ ------- � Owner's Name------- ---x`11-/�.-fl� --,---- - -• - - - - -- --- ---- --- ---- --- ------ - - --- Phone. - ------- � ,Address-------------------7110---3--Q-- 1;Z- -- ----------------- -----•-------------------------...... Contractor's Name------------------ ! -------------------- PhoneACI�T.0_17,7_----------- j Installation will serve: Residence f Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms ___ Number of baths.4r__ Lot size':._ Water Supply: Public system ❑ `Community system ❑ Private;9 Depth to-Water Table71.__ _ ft Character of soil to a depth of 3 feet- Sand $1 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date-.................. } No New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No�" - TYPE-01"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 ._..-.-.-.--. ------- ---------._____.._. ❑e)( No. of compartments--------- ----------- ----Size-------------------- -----------Liquid depth- Capacity----------------------- � Disposal Field: Distance from nearest well./�PQ___P----Distance from foundation__: ---------Distance to nearest lot line-le- RL Number of lines.-- _. Length of each line_- ---,SVn___ ----------- '?--------Width of trench-__ZQt_�(-___________________ a Type of filter material_ C_..' Depth of filter material___ ___ _________Total length----/I'll? ---------------------- Seepage Pit: Distance to nearest well____------------------Distance from foundation------------------- Distance to nearest lot line--------.-.------ Q!l ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- + L.4 Cesspool: Distance from nearest well ________________Distance from foundation----------.------ ..Lining material-------------------------------------- 0 Size: Diameter- -- --------- -- ----------------Depth-------------------------------------------- ----...Liquid Capacity----------------------------gals. , Privy; Distance from nearest welt-------------------------------------------------Distance from nearest building--------------------------------- -----._. ❑ Distance to nearest lot line --- ---- --� --------------------------- ---- --------- -- ----- ------------------------------------- - Remodeling and/or repairing (describe):-- ---- - = -.----- ----------------- - --- -- - - - ------ --------------------------------------------- --------- --------------------------------------------------------------------------------------- --- ----------------------------------------------- ------------------------------------------------------------ 3 1 hereby certify "that`I h prepared this application and tha the work will be done in accordance with San Joaquin County ordinances, State laws, and r sand regular' sof the San Jo uin Local Health District, r (Signed)-------------------------- ---- - ------ ------------------- --------------------- --- - (Owner and/or Contractor) gY--------------------- --- --- -- - - - --- ------------------------ -----(Title) - -------------------------- (Plot plan; showing size of lot, location of syste in relation to wells, buildings, etc., can be place"n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ T;RP 6Z -------------------- ----------------------- -------------- DATEA1_O`Z�_-�� -- - - - ------------------------------- -,REVIEWED BY-------------------------- ----- '-------- --------------------------------- ------------------- -------------------------- DATE--------------------------------• ------------------------ BUILDING PERMIT ISSUED-------- ---------------- ---------- ----------------------------------------------------------- - DATE---- ------------------------------ -------------------------- Alterations and/or recommendations---------------------------------------------------- -------------------------------------------- -------------------r---------------------- -- ----- -- ---------- ----- ---------------------------------- ...................... .......................... --- ----------------------------------------------------------- ----------------------------- -------------- -------- ------------------------------------ - -------------- --- --- --- --- -- .... --- - ------------ ----------------- ------------------------------------------ -------------------------- FINAL INSPEGTLON B • . - ----- Date----- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 245 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguord Press