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FOR OFFICE USE: ----- -- ------ ---------- -- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. _01Kz:lf 7 -" -- --:--- - -------- ------ (Complete-in Duplicate) This Permit Ex ires 1 Year From Date Issued ` Date issued t�lP_ _ Z r --f 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 ANDLOCATION-------/--- ------C&�---- Owner's Name t �--� �'�-�e !'E 1/- X/_/---- ---- - - -------'--- ----------------------- - Phone------------=------------------------ Address ---------- �n .. ...•.--S------ � ------------------------------------- -------...----------------------•---• - �l,,�¢ Contractor's Name----- f'-F�/G�� -' Q/ r--------------------- -:-------------------- Phone--------------•--•---------------- Installation will serve: Residence [E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑o Number of living units: _l_ Number of bedrooms -?--- Number of baths.-/---- Lot size /__, -_ f ------ ------------ Water Supply: Public system ❑ Community system 0 Private RR-tepth to Water Table "a ft +- y Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑'" 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 sewer is available within 200 feet.) T � 00 � Septic Tank: Distance from nearest well.:��_-.-._Distance from foundation_��-__,______.Matprial a6_,el��--------------------- �� No. of compartments--. _________________Size_ :___ X3-Liquid depth---�l._� Capacity/��_._-_ i i Wi ---- ------- op Disposal Field: Distance from nearest we€l.46; �. --_._._Distance from foundation__Zi _____-Distance to nearest lot line____4�____-_____ fi Number of lines______ -___ ,� . ___--. - ------Length of each line___-�L9Q.....-.........Width of trench_...e�-___�_.______...-__-_.. Type of filter material/! r'.�..__Depth of filter material___, .._. otal length---.�,�1�------------------------- Seepage Pit: Distance to nearest well...;j�/.��---_.Distance fr m foundation--_ -a-__.Distance to nearest lot line___b��___�. Number of pits___ . — Lining material-Zle��°'_ Size: Diameter._3.3.��___-.-Depth.._a��_______________ k Cesspool: Distance from nearest well _______________Distance from foundation---.------------- ..Lining material---------_-"--_-._.--.-._________-_. ❑ Size: Diameter- -- --------- --- ----" - __Depth.... ------------------------- ---------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building.-____-__________-.--______-__._._-.-._. ❑ Distance to nearest lot tlineA..---. "-----------"--�--i------- - ------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) '`nef`:._!Y--- ----------------------•------------------ -------------------------•-------------------------------- --------------------- ------------------------------------------------------------------------------ ------ --------------------•---------------------------------- ----------------------------------- ---------------------------------------------------------•----------------------------------------------------------------------------- -------------- -------- ------------------------ 1 hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a (Signed) t' et:xacl{or Contractor) �� _ . _ _ '-$Y•---- ----------------------�---------- _ -_ �� -- -(Title}--- - -- - --- -• -- �---�- �---------------- ------ - (Plot plan, showing size ot,lot,IOcation of system . elation to wells, buildings, etc., can be placed on reverse side). OR.DEPARTMENT USE ONLY' APPLICATION ACCEPTED B - ------ - ------- - ------------------------ -------------------------------------- DATE . - -------------------------------- R•EVIEWED BY------------------------- ------------- -------------------------------- DATE----- "--------------------- ----- -- ----------- ---------------------- BUILDING PERMIT ISSUED.-------{-- - -----------------------------------------------•-----------------i------------------- - DATE------------------ -------------------------- ---------------- Alterations and/or recommendations--- ------- .......:_............= -------- '----------------------------••-------•------------- ---------•- ---------------- -------------------- -- -------------------------------------------------- --------------------------------------------------------------------------------------------- ----------- - ------------------------------------ t ------------- ------•-... ------- - -------- -----------.--------- ----.----.........------------------.-----------------------------------------.--------- . . -------- FINAL INSPECTION BY:.. , - ,�' --------- Date_. ___A __0_d......... ------------------------------- 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,California E.H.9 2M 1-67 Vanguard Press t