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FOR OFFICE USE: ------------------- _ Permit No. ---- ------- - ------------•---------.--------------- -- APPLICATION FOR SANITATION PERMIT } • (Complete in Duplicate) Date Issued-r6 k ------- ------------------------------------------------------- -------------------------------------- ---- This Permit Expires 1 Year From Date Issued --- ---- ------------------ --- 19-pIJ: Application is hereby made to the San Joaquin Local Health District for a permifi to construct and Ie warX herein described. ! This application is made in compliancevtth County Ordinanc No. 549. . ' ' j JOB ADDRESS A D LOCATION. _. 7�- -- - t '�" Ph ------------------------- ------ Owner --------------- - _�_ -' = 4/ Address------------ _. T - -� -, = � - -- --x - one_ Contractor's Name--' `--=--- " Ph moi` �w f `" 'dente A�artment House Commercial ❑ Trailer Coin❑ Motel ❑ Other ❑ l I Installation will serve: Residence 15'" p + � "" Number __ _ of baths ___ Lot size _________ 3--- --� � ------"-- Number of living units: Number of bedrooms Water Supply: Public system ❑ Community system ❑ Private epth to W ter Table _- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Er� New Construction: Yes o ❑ FHA/VA: Yes ❑ No [I .z ' TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool.permitted'if public sewer is available within 200 feet.)-� -��T -g Sept o dation_ /® teri I -- Se tic Ta Distance from nearest well_ -- Distance from f No. of compartments___"----.-- - -t .�• � Size � �r - �{�Liquid depth_ ._C......- -------Capacity. j__. _____._Distance from foundation___d� -_f__--"Distance to nearest lot li e__ r _�V1 I Disposal Field: .Distance from Weare t weIIT - �` 47 ZC1Width of trench.. "- -----t--•-- Number of lines___---: Length of each line-_ --- �� y pp yp 9`0Depth of filter material_;_'" ___ - ---_Tofal length-------- f -----F----- C 1 ------ Type or filter material_ to nearest well____ ____________.Distance from foundation"_____.____.._____.Distance to nearest lot line___-__`_____... Seepage Pit: Distance " , ------: Number of pits----'-_-- "-- ----�.Lining material_____.__- ----"- --f 5ize�i Diameter�----�---------------Depth------------------------ ( Cesspool: Distance fiom.neares# well_____"_____.-__Distance from foundatio'n--------__..f_�_. Lining material__.. _:---------r--_____-__.__-.___. 1 Size- Diameter___;.:---------- p ' ❑ De th -------- t ------ -- -------=- ".Liquid Capacity----------------------------gals. Distance from nearest well----------------- -------------------------------Distance from nearest building-------------.-------------- Priv ---------------- -----------._ ----------- ---------- ... --------- Distance to nearest lot line---------------�-- ---- "�" i Remodeling and/or repairing (describe)------------------- ___ _._._ - --- ------------------------------------------ i_ ` _ " ..fi . - _____________________"_______'____ --- - ----------------------------- •- ----•---- -.----- -------------- S - - an Joaquin aquin aunt y I hereby certify that ave prepared this application and that the work will be done in accordance with Sa ordinances, State laws, a 61es and regulations of t n Joaquin Local Health District. -- Contractor) _ -------------- ------- --------------- (Signed) -------SSpT C�.-rANK"-SF_RV10E------------------ ---- ------ B . 2915 E Miner Ave • HO.6.3841 - . -_ __(Till - ----- ---------------------------------------- ;1 •. e) Y' ---------------------- __ {Plot plan, showing size of lot, Iota#ion of system in r ati to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- p • ----------.......... .- ----------------- DATE S ��-� I REVIEWED BY---------------------------------- --- ------------------------------- �: - -------, ---------- BATE- ---------------------------------------------- --------- BUILDING PERMIT ISSUED-----------------6-----------------------------------------------_-- ------------ - -- DATE__;---------------------------------------------- Alterations acid/or'recommendations:------------------------------ ---- --------- ---------------------------------------------•------------------ -- - �.., ------------------------ ----------------------- --•------- ------------------ ------------ - - _ -_... _-----------_ ----- --------- ---- ---------------- ------- - ------.-- f ----- -- ------ FINAL INSPEC L�� l ��----- / �- Date_- ---------- 'a-------------'_----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Ha=anon Ave. 300 West Oak Street 124 Syca'mare Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California