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r rvK Vrl-IC.t u5E: _------------- ----- ------- -----------------------------------------." APPLICATION FOR SANITATION PERMIT Permit No. _ Ovl� (Complete in Duplicate) _ ------------------------- --------------- This Permit Ex free 1 Year From Date Issued Date Issued _ 7,26:"45- 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 w' County Ordinance No. 549, JOB ADDRESS'AND LOCATION_'_ . _ Owner's Name ._ --------- - Phone Address---. ... F® - --------------------------------------------------------- ------------------ Contractor's Name-------- `9_ �. _ Wil-S� /Y-�'-------------------- "- Phone------------------- - Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: __�--- Apartment bedrooms / +� +"� �,...�...�.�,. ..,. .,,,_. .,.�. +-� :Number of baths f��Lot size ___� Water Supply: Public system ❑ Communit s stem Y Y ❑ Private 19 Depth to Water Table L� f}• t i Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay. Loam [] Cla ! y ®. Adobe ❑ Hardpan Previous Application Made: (If yes date--------------------) No� New Constructipn),Yes , No ❑ FHANA: Yes ( No ❑ TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-1LP__`_Disfance from foundation_A0 __" Matial No. of compartments______.__ _- Size---�� y-- -- ----- -- ------------------ --------- `._ ..--Liquid depth---- -.--------'Capacity Disposal Field: Distance from nearest well_ "--_-.Distance from foundation_ /a r"--". Number of lines___-___,j_.___ ------ Distance to nearest lot line----- fl ....__Length of each linec_f_�5_I4?`1"Width of trench--kyr-�`" Type of filter materia _'PBG'.�4''_._Depth of filter material___._/g' --------Total length----- _-r______-___---- --- Seepage Pit: Distance to nearest well-_4RL9-_�.._ _ Distance fry foundation---- Distance to nearest lot lin �_- -."• Number of pits._.._,._-___-____."Linin material--�//�® fi i/ Lining !� -Size: Diameer__.3 _- --- Depth___ _ _ _______ Cesspool: Distance from nearest well-___ _--_---_ -Distance from foundation-------------------,Lining material__._______-"-____...-_-" ❑ Size: Marneter---- -------------- ------ -----........ ---- ---Depth- ----- ------ ---------- -------- -�-t-i -----L'rquid,/CapacitY'--• -------- - Priv ------- ---gals. t Y Disfiance from nearest welLDistance from nearest bu'ildin ❑ Distance'to nearest lot ime--------- ----------- ----------------- -•--t, g ------------------ i---- --------- --- -- Remodeling and/or repairing {describe):_..-_---� z. ----- �'7" � k - ------- d f --------------•--------------------------•-------------------------------------------------------------- 1W------- - -------------- ----------------- - ------------------ d I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o e an Joaquin Local Health District. F I ------------------ - -- ---------------------------- -&wner nd/or Contractor) BY� T'tle) ( a (Plot plan, showing 51 of lot, IOcatio of system in relation to wells, buildings, etc., can be placed on reverse side. -- -------- --------- - ----- 1 FOR DEPARTMENT USE ONLY I APPLICATIO �ACC�EPTED BY...- ----------- DATE--,4/-- --- ------------------------------------ REVIEWED BY------ ---------- - --------------- BUILD1NG PERMIT ISSUED ----------- ------------------------------- Alterations DATE---- Alterations and/or recommendations:__------- ------------ =--------------- -------- -- DATE. ------ ---------- ------------ r< ----------- --- q`+►,,, - f 16 ________________________________________________ ________________"___._"._-"_____...._._"___--""_-.""__.--_.-___.____-"--_..__---"--..__--_ �- ________________________"___-.-_-.._.---_______..._______- ._""__-"_•_•__•__.."____....--""._-_""__-_•-___•"_"-•-•_..."_""" FINAL INSPECTION BY,24_ 1 i ------ --- ------- Date--- �--'�-�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California "d1 Tracy,California F.P.CO. p?y a