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FOR OFFICE USE: ; I --------------- _6 -la-_____-I1-. APPLICATION FOR SANITATION PERMIT Permit No. . �� _ IM (Complete in Duplicate) .. --------------------------------------------------------- Date Issuer! ._.f- This Permit Expires 1 Year From Dam Issued 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. ""' " '""� JOBADDRESS AND LOCATION----•----� �------------------------------------ ------------------------------------------------ - -------------.-------------------•------------ /�yy Owner's Name.021 -- I - -------=---------------------------- Phone------------------- 11 -• -------- -----•-- Address--------J4... ------ I---- -------------- i- ---------•-••----...----------------------------------------------------• ---------------------------------------- - ------ Contractors Name----- !I ---- --------------- T.- ------ ------ Phone-------•-------- - a Installation will serve: ResidIence E] Apartment House E] Commercial Traile"r Court",F] Motel Other ❑ IS; Number of living unitsfl_____--- Number of bedrooms ________ Number of baths Lot size' t.�t.!!�✓_________ ----------------- l t a Water Supply: Public system E] Community system E] Private �pfh to Water Table -4-Kit. �... Character of soil to a depth�V 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff Hardpan C]'- Previous Application Made: (If yes,date.----------------- -) No [ New Construction: ryes No ❑ FHA/VA: Yes ❑ No Et' TYPE OF INSTALLATION �ND SPECIFICATIO_ NS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'IM r < ` �4. .. Sept'T nk: Distance::from nearest well__N.0----__Distance from fooundaattiion___la__._______-Mate;;al______ _ _________ _ "' __ ------- No. of compartments---3-------------------Size---_��__ ' _#cd<--nJ__Liquid depth--- .-----.------ --Capacity-121-04!P0. --- � del � , Disposal Field: Distancei�lfrom nearest we113D_......-Distance from foundafion_/O-------------Distance to nearest lot Ifine__�_-____- 1 [ � Number bf lines______2_ . ..__Length of each line____l .___.____--._-_._.-.Width of trench _____________________ Type of filter Depth of filter materiall8_'4-------------Total length----,tea___________________________ tII ,or R i Seepage Pit: Distance to nearest well-JOP...........Distance from"" foundation----l_4_______-__ Distance to nearest lot`line�_�_----- Numberiiof pits_______-------Lining mat erial_..��jG/i _-Size: Diameter__.3._f1-------Depth_________ J----______-- S + Cesspool: Distance from nearest well-------------____Distance from foundation----___.___r------- Lining ❑ material__.___.___._ j''_---------------------- Size: __._ .______________ Size: Diameter----- ----------------------De th--------------------------------- -- - ---- ._-----Li Liquid Capacity----------- - - ----gals. � Privy-- Distancalfrom nearest well----,-__, ___________________________________Distance front nearest building_.._._...______:____-_..___.__.._.___..�t- ❑ Distance °to nearest lot line--------------------------------- ---------- ------------------------'------ ------------------------------------------------ - -------- Remodeling and/or repairinc: ldescribe): --- 1r -- --------------------------------- ---------- --------- ----------------•----------------•------------------------ ` 1C2�a -_!= �'C97a�Ci �J--------' � =�'Zf �� t ------- ------------------------------------------------1 --------------------------------------------•-------------------------------------------------- -------------------------------------------------------- --- ----------- I-hereby certify that I Ave prepared this application and that the work will'be done in accordance with San`Joaquin County } ordinances, State laws, nd �Irules an re ulations f the San Joaquin Local Health District. t (Signed)------ -�Ih — -------------- ------------------ ------------------------------------(Owner and/or Contractor) B -------------•- Ir-------------------------------------------------r----------------°--------------------------------(title)-------------------------------------------------.----- ------- (Plot plan, showing size of 14, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDI�BY j ...d_927--------------------------------- DATE---------�--7-f-r-4 ------------------- REVIEWEDBY------------- --------l--`------- - ----- --- -------------- ------(J - ------- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED�I. ----------------------- - -- TE Alterations and/or recommel dations:._. c -'S--� _ - = ----•-•------------•------------ ------ --------------------- ------------------- ---------------------- ------------- ------------ - ---------- ----------------------------------------------------------------------_-------------------------------------------••--•---•------ ---------------------------------------- ----- �------ --- ------- ---------------------------I---------------------------------------------------------------------------•------- ------------------------------------ ' II ------------------------------ -- - . - - ------ -------------- -------------------------- ----------- ----------------------------------------- ---------- ` i II -------------------------- _ _ -._.-_.___.....__.__..___.__...._______.. ____..._..___..____ ..______ _._ _-_________... FINAL INSPECTION BY:.' = l- ------------- --------- Date--------- ------------ - --- - - - ----------------------------- r,� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California I Lodi,California Manteca,California Tracy,California ` F