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z r .,FOR OFFICE USE: �. ------------ ----------------- - ---------------.---------------.. APPLICATION FOR-SANITATION PERMIT Permit No. ------------------------- - - ...... (Complete-in Duplicate) �(1 I This Permit Expires 1 Year From Date Issued Date Issued _-- __Z� Application is hereby made to the San Joaquin Local Health District for a permit to construct and ' all the work he ribed. This application is made in compliancewithCounty Ordinance No. 549.. JOB ADDRESS AND LOCATION F --- �, " 7"Ta--or Owner's Name------ ---- - �C:�----- --- - - ------•-•------ --- -------------- - ----------------�-'-- ------- ------------ Phone------------------------------------- Address_.. --------- Cant ractor ------Contractor Name------------- 4L�: -tom ------------- ��•� - ............ Phone-- -....... - - Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: /._-_ Number of bedrooms —Number of baths&)?_- Lot size .../I---.- ---_--- -------------------------------- Water Supply: Public system ❑ Community system ❑ Private Or Depth to Water Table Fes_ ft (� Character of soil to a depth of 3 feet- Sand 0 Gravel ❑ Sandy Loam;K Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------:------- _- J No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: .(No-septic-tank-or cesspool per-miffedifpublic sewer is available within 200 feet.) Septic Tank: Distance from nearest wet! ..-_Distance romJ/am' oundation-..�O-_.----..Material --- ---- ----.__--. No.'of compartments-----.ez._.-- r Liquid de th- _ Capacityd _e5'a jSize Disposal Field: Distance from nearest well-4 —am.-_-_ Distance from foundation-�Q-- -_-.--Distance to nearest lot line---t �--, Number of lines--- _— __--------Length of each line--. ._. �r ---- - 9 �Q-�. - - -Width of #Tench-----�-- !� Type of filter material- .---.Depth of filter material_ ----------Total length---_117 ----------------_---- 1 Seepage Pit: �- Distance to nearest well- � --.Distance to nearest lot line__-�_--T Number of pits... --------._Lining material.-. r ___Distance fr g 1 SIZE:nDiameter. t Depth- � ------------- - Cesspool: Distance from nearest well ----------------Distance from foundation___ _........... ..Lining material------------------------------------- ❑ Size: Diameter- - J------ ----- --------------- Depth-------------------------- - - ---------------------Liquid Capacity----------------------------gals . \� Privy: Distance from newest well----------------------------------------- __ -_-Distance from nearest building------_-----,-------____-----------_-_-. ❑ Distance to nearest lot line ------------- - - } 1 Remodeling and/or repairing (describe)--------------- -------------------- ------------•-------------------------------------------------------- s l I ----------------------- ------------------------------------ -------- •------------------- -------------------------------------------------- ------------------------------------------------------------------•----------------------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County i ordinances, State laws, and rules and .regulations of the San Joaquin Local Health District. ---------------_--- I r (Signed)... - - -- ------------- -- ------- Owner and/or Contractor) B - - (Plot ple`n,showing ize of"Iafi;' ` anon of syst in relation to wells, buildings, etc:, can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- REVIEWEDBY------------------------------------------------ ------ ----- - ------------------- ----------------------------- DATE_ i BUILDING PERMIT ISSUED-------- ----------------------------------------- ------ ----•------------------------ ------------- DATE Alterations and/or recommendations:- + ----------------------------•- ------------•----------------•-----------------•---- ------------------------------_----------------- ---------- > ----------- -------------------------------------------------- --------- ----.-------_------------•--- ---------------------------------------------------- ---------------------------- •---------- -� - 1 -• ------- -------------- i= ----.-- --------------------------------------------------------------- - ---------------------- -------------------- -------•---------- --------- t FINAL INSPECTION ---------------- Date-- 7_1 ------------------------ SAN -----•--SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:slton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.92M t-67 Vangaard Press "j }