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FOR OF fCE USE: '�".... 3_ I�' APPLICATION FOR SANITATION PERMIT Permit No. .. ... ------- -- ---------- ------------_------- �l .. 1 (Complete•in Duplicate) - - Date issued ------------ - ---------!��'__- This Permit Expires 1 Year From Date Issued - --- - Application is herebymadeito the San Joaquin Local Health District for a permit to construct and install the work herein described. } happlication is made in Compliance with County Ordinance No. 549. I� ��' �a � �c�cfi JOB ADDRESS AND LOCATION Q �� '----------cam- k t -------- Owner's Name--.. _l/_ 4 !" fT `L2---Q-Y_ 1`F1 ----------------- -------- ---- Phone__'4 _ _`_ O.A- -----Yat.--1► a� = Address__ ri .} A -------------- -•------------------------------------------. ------ -------------------• - ------- �° Contractor's Name .JQ_Yta- ::{ 11-C' ------�- Phone.- t AA---PA�`-Y LS�--- -------- Installation will serve: Resi encs 1g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living un 4s: f___ Number of bedrooms CNumber of bahs J... Lot size _____ ___ ____ ____ -------- --------------------------- " -- mmunitY system ❑ Private ❑ Depth to Wafer Table ------ - ft Water Supply: Public sY ~st —19 o Character of soil-fo a-depth-of-3-fe06r Sand X] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made.: '(i.f yes,data............. ) No New Construction Yes No E] FHA/VA: Yes E] No 4 TYPE OF INSTALL-AT40NND-..SPECIFICATIONS: I (No septic tank or cesspool permitted if public sever is available within 204 fee},) f A from nearest well-4.046-Distance from foundation_ .-".- -.. •-'-MAr�ali----------- --- --------------------------- c, !___.___.-..-.----.__ -. Septic Tank: Distant , No. of Mcompartments------------�'Z------ --.-.Size----'•- ©__.q6i�_ _aLr aid depth , I-------Capacity-----&Oar/_ Disposal Field: Distance from nearest well.................Distance from found ation___:,_____-..._.- Distance to nearest lot line_____...____. i , <��c- -----.Width' Number of lines.---------`�-- -----t---�- ----Length'of each line__ - ---`------- of trench----_./6 ;--------•---------- ci- .-._-_-De Depth of filter material_--J9•-1__.Total 'length--'.__.�_�0.__._ � Type or filter material__-_�_. 4-!S' --"-"-"- I p I ` � � � Seepage Pit: Distan iA` fo nearest well----------------------Distance from foundation--------------..--_.Distance to nearest lot line_.________..__._ ❑ Nurn of pits.-- ------------------Lining material---------------- .... Size':'Dia meter----------""••`:-.,_Depth--------------------------------- Cesspool: Distan& from nearest well ----------------Distance from foundation____------------ _Luning material__________________ ________________ EJ Size: Diameter ...----- --- Depth ..` ;gisicff Capacity gals. ._Distance from nearest-'buildin Privy: Qistanee from nearest welk---- -------------------------------- - = g--�--------------------------------------- i ----------------.------ - ------- - .. ❑ Distance to nearest lot line................ -------- -- �-------------------- ------ f ________________________-_-.____-F�___________.._ :'_ _._____.�__-..._. Illik� ------------------------------------------------------ I� Remodeling and/or repairing (describe)----------------------- ---------- --------------------"-" ------------------------------------ . IM ----- ------ y -------- -------------"-------•------------------------- l -------------- --------------------------------------------------------------------------:--•--------------------I------------------I-------------------------------------------------------- -- --------------------------------------------------------------------------I-----------------#-- -------------------------------------- ------------- I hereby certify that khave prepared this application and that the work will be done nl accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - � 1 C(Signed) D.- l' -9kl"Y.I �d YEj_ �------------- -------------------+------------ (Own and/or Contractor) BY= i -r Title-. -- ----------- (Plot plan, showing size oL'! loc ton of system in relation to wells, buildings, eft., can be placed on:reverse side). FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY__.._ ==-QAT,E._>-- "( -' -- ---------------------.----- REVIEWEDBY----------------- X11-------- -------- DATE --------------------------- BUILDINGPERMIT ISSUED-------- ------------------------ --------------------------•- ------------------------------- DATE n� Alterations and/or recommendations:---- ---------- -:�--- -�• ---•-------- ---- ---�-------••---:----_�-------=�--:-------�::. :��;,:�.;; -- --------•---------------------- .. •---- --.. ----- ---- } II -----10.0 --------------------------------------------------- -- - -------- ----------------------------- ---------------- ----------------- --- ------------------- ----------------- :- a1; -------------- ------ ------------- -------------------------------- ------------------------- ------ ------ ------------ --- --------- ----- ---- -------- ... `4 3 f t - i. w_ a- �,. -------------------------------------------------- '-------- ........................................... �`. ._.. -� Date......:;--'�` -------------------- ---------------------- FINAL INSPECTION BY:__. -- ----------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi. CaliforniaManteca,California Tracy,California Stockton,Calitarni� - " E.N.9 2M 1.07 Vanguard Press