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FOR OFFICE USE: ;. I I '1( APPLICATI(N FOR SANITATION PERMIT Permit N - .._-------------- . �- " --• (Complete in.Duplicate) II. i ------------------- ----- - Date Issued .---I-fQ / --------------------------- --- - ---- - -- This Permit Expires I Year From Date Issued II. . Application is hereby made i�o t e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in co mpliance with County Ordinance No. 549. -�I r��Iq`m CP+ f I. JOS ADDRESS AND LOCTION. �r P ----- ,t_� ------- = . r- i 1 1� f �: 0A-------------- M �j: Owner's Name----- - ' ------C.-K. 4_r__5. ..�........ ---------------------------- Owner's - _ u ------------------- Phone ------ Address-------FT�--------- ----y------------- - "_-- I Ilpb v ,. IJ' E-1) I-I' V Contractor's Name_.._.._Q Ii� _ -------------------------------------------- - one I �/Mote! Other Installation will serve; Residence;',❑ Apartment House ❑ Commercial ❑ Trailer # LTJ _ ❑ ❑ II t Number of living units{_,- - Number of bedrooms ___!___ Number of baths __1_-- Lot size .".14C-�'I- + ---- P Water Supply: Public'system'❑ Community system ❑ Private Depth to Water Table` ft. I 1 11-- Adobe Hardpan Character of soil to a depth of 3feet: ' Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ it ❑ ❑ Previous Application Made:�N(If re'�s,date_.._- ---------) No New Construction: Yes JZ,-No ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (N septic tank or ce�sspaol..Permitted'if_public sewer-is,available within.100 feet:).:�� Septic T k: Distance from nearest we14:_ _-_Distance from foundation" . IIII n -- ' � - - ofompartmeSize._ -- x - - ------ No. - ---No. _ hp I ��_._.c____Dis+ance to nearest lot li Disposal Field: Distance from nearest well--.,5D.____-Distance from foundation_____ f Number of ltA ines---------- ------`---------- -----Length of each line------L� --- --width of trench---II - _---- -- yp I p g e rest = ' _�I p ndation------------•--- .Distance to n a I' T � of fi}ter material �C�""-De Depth of filter fouterlal_. __ ��-- Total length t lot line"_._____________ (�1 Seepage Pit: Distancelto nearest well ----------Distance from ❑ Numbe Of. its ---- .Size: Diameter Depth-11 - Lining material___._____._______.-_. i Cesspool: Distance om. nearest well_ ____________Distance from foundation_- Lining material i- I�I°--__________ _ ls De th.-------------- Liquid CapaFity---------------------- gals. � .Size: Diameter�- ------------- ------------ -- P ----- ----- ------ ------- ------ Privy: _ Distance from nearest well------------------------------------------- ----Distance fro'rri.`nearest building._- J------------------------------- ,y ____________________ ❑ Distancle to nearest lot line------------- ----------- ----------- Remodeling ----------------- --- ' .� II. - 6 ll 67 •► .--------145------��cz�_..c�Q��__:�t-� ?Q� e-� Remodelin and/or repair' g (describe):_..____-. _ 9 p . --------------------------------- ------)------------:-z------------------------------------------------- Ro 1)= d ' = - W M '--------------- --- 1 = ``' t----v. ---- ------------- - A= �p p p--w-----------=-- ---------------------------------------------------------------------------------------------: I c I hereby ceriFify thk ha),e re aced this"a lication and that the work will be done..in,accordance with-S`n Joaquin County M; ordinances'. State laws"aria rules and regulations:of the San Joaquin Local Health District. 0 �� ' ------------------------ ----------------------------------------------- (Signed) _-____(Owner and/or Contractor) --�1------ ----- ----- III Plot Ian.,=showing_size_ofN�ot,_ ocation-of.system-in relation Jo weNs,-buildings, etc._ca b placed�ott-reverse-side): .y:------------------- ---- -�-----^- »- I P l FOR DEPARTMENT USE ONLY --------------------- i DATE------------------------- �j APPLICATION ACCEPTED BY---------�.f�_-' ---- - ------- ------ ----------------------------------- DATE----- ,.r BUILDING PERMIT ISSUED------_- -�„---- --- ------------ ------------------------------�-------� --- - ATE- -�.---:-�---_2-- REVIEWED BY----- - ------- --- ------------ ...................................... I x . , - �M.- =r - - ------- Alterattons�-and/or recommendations:- ._;T_ ----------- --------------------- -------------------------------- ------------------------- z I ------------------ ----- -------------- =-------------- ------------------------------------- - _---- -- -------------- - ----------- ---- - - � , I FINAL INSPECTION BY: Date----------- ---- --- j------ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT II 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4tir Street Stockton,californilLodi,California Manteca,California Tracy,California ES 4 REVISED 8.59 3M 3-'6I3 F.P.CD. I� i • . I II