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FOR OFFICE USE: -I—tAU 1 G - ------------- - ----------- ----- --------- - Permit No. . APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - Date.Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct arinstall the work herein d cri This applicaRES is made in compliance with County Ordinance No. 549., ��c�l €�5'-1&0 -2 S)171=- C�-! t-�on� ( !y ---------JOB A€)DRAND, 4OCATiON ----- t f �s - - - - Owners Name `l a%---K:__-- Address.-•--- am �'_d-._�a.X.!lk f--------------------------------------------------- -- Contractor's Name_AN-M0N_y_-,:±_---:e. 9- ----- Phone------ •-----•---•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑+Motel ❑ . Other El Number of living units. j Number of bedrooms 3---- Number of baths -1----- Lot size - ��--�7b x � - Water Supply: Public system ❑ Community system ❑ Private EA.-,,Depth to Water Table l.--�. ft. Character of soil to a depth of 3 feet: Sand [T ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hard n ❑ Previous Application Made: (1f yes,date_..-.-- •� )-.No I2lNew Cortructio�n: Yes ❑�.NoA/VA: Yes No [], _ I. ., 1. TYPE OF INSTALLATION AND SPECIFICATIONS: 116 {No septic tank or ces pool::permitted�if pubri sewertis available within 200 feet.) r 1" llo ------- Septic Distance from„nearest wall_.?_____._-_Dispri �e from foundation __ _______ _. � � L 1 _ Size_ x Jam -Li wd de th__._ capacity___Ir�®_O No. of c impartments--- �• _._ _ ' - q p. �� r . ____._"_____Len th of each lineY57-- 1-O-.-_._.-Distance to nearest lot li _____ : �" r 2:0 ----- Width of trench --- 3&.1f-- --� ------ ' . l Disposal Field: Distance fFrom.,nearest well._____ .___ ------• I _�- -_-.Distgance from�foun�� "- �X%511J j� Number of lines________ __ , j. ria otal len th------- 5-5--------------- -4- --------- . 1 � �3DD' Type of filter materi l--"�Q_LK------Depth�of'Efilter�mate .`l� -g��9 Seepage Pit: Distance to nearest well----.-----_!,______---Dis�t�anc&.from foutdation__"________________ Distance to nearest lot line_____.._-,-___._ ❑ Number of pits---------I--------4 Loring matera.al----------------if -Size: Diameter--------- -. Deptn-----------------------------•.._ Cesspool: Distance from nearest well-*--- _____.___Distance from,foundation____...............Lining material_-----...._.__..___----___.._________ �" ' ___. Li ujd'4 Ca acit gals. ❑ Size: Diameter.-- --- f-- ----- - -------- ------------ #:r.p.a:. y' - . ».-�, t . Distance from nearest well--. ~___ ___ _ ____ _____r~Distance,rfrom,nearest �ild,ng�--------------------------- Privy. ___.- -. ❑ Distance to nearest lot line _ ---- 't € U Remodeling and/or repairing (desciiibe):_._ XIiS'7'7 -- ------i? --- ,f4p�Qnlr�U�_ - &-Wh-r1 a-r . .. - c4 - 3 Ri__r'C s `5 7r r ' =y ------ ------------------ --- ------------------------------------------------ ------k_- ---------------------------------------------------.------------------p - '=; ,----------------------------------------- ----- � I hereby certify that I have prelpared_this,application.a!nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. "" t7710wner-and or-Contractor (Signed _= 7 - ------------- --- ------_---- - - - -- ---------- ------------------ ` (Title) - By:.---- --------- ----- z. ------ ---------------- - ---]- ------ (Plot plan, show g size of lot, location of sy to on to we , uildingss, a+c`'t ca be placed n reverse side). FOR DEPARTMENT USE ONLY --------------- DATE- .-��----"--�Z'low _ APPLICATION ACCEPTED BY__�i��. ---�-'--�--------- ---- ------ ----------------------- ---- - -- ------------------ -- REVIEWED BY-------------------------------- -----------_ --- DATE- - - BUILDING PERMIT ISSUED--------- --------------- - DATE------------------------------------------------------------ ` _D.+. .4 T --------------------------------------------- - ---------- - ----------- .._� ...--- -----•-- -------- -- FINAL INSPECTION 8Y- _ _ -- --------- --- - Date------- ------------2 -- Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California " 1:odi,California Manteca,California Tracy,California F:P.GO. ��i