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,¢ 7R GfFICE USE: APPLICATION FOR SANITATION PERMIT a' ". ; • ------- --------- --------- ermit No. -.1Ls.._` ------------ --------------------------- in =r per{ _ w.. (Complete Duplicate) Date'Issued _' �-{0 - --- --_ . ------------- f ------------- --- f This Perrn'&Expires 1 Year From Date Issued Application is.hereby made to the San Joaquin LocarlHealth District fora permit to construct and install the work`herein described. /�NTEE_C r- This application is made in co 'pliance with County Ordinance No. 549. _ ,_ JOB ADDRESS AND LOC ION _r_�f D E-.-- L UEiZ-L A --___ iCi� --- T•--__C� ---__rV-,_.___ 1 1.' --• l; ALI I - 1 1�_ �_ n�:- ---_- -- ------- Owner's Name------------- C __ ------- - ----------- - Phone---....: j,� n�� _:----------------------........... •------------------.-.. Address----------------- _.`_ � `. -; -- / I _-------- Contractor's Name-----�:��/E�,----------:P".n-------------------------•--------- --------------------•----------- :•---- ------•----.._. Phone-------•--------------•------------ t ti. Installation will server Residence ��pa�rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , J Q I Number of living units: _-1--__ Numbs of bedrooms -- Number of a#hs'-- ._ Lot size ____ C�---- r Water Supply': Publics stem Community sys 'rr ❑„RP'rivate. Depthto Water Table 0 ft. ; Character of soil to a depth of 3 fet: Sa Gravel ❑ SandyLoam❑ Cly Loam ❑ Clay ❑ Adobe ❑ Hardpan E] 3 L��Previour-Application-Mad (.If��s,date. _'^--1 Na: N Gonst�ru�c#ion:=Yes-ons ❑ -FHA/VA.-Yes-E] —Nam" -: Vil TYPE.OF;INSTALLATIION,AAND SPECIFICATIONS: -;, s t�A mv-10 ¢ (No septic_tink or,ce#spool permitted-if public sewer is available within 200 feet.) 4 " oundation------------------Material----_--------------------------------=-----•---- F wel - - ----- p Sat Distance from f n_� n {-- Noof cbm artments-- - -------Size--------------------------------Liquid ° depth------------------------.Capacity--••-------•---------- f t ' �V.._--___.Distance to nearest lot lire.------------- Disposal ___-_-..--�{-. Dis osal Field: Distance from nearestavvell-.- .__-Distance from founds#ion---._ i 1>11'I�C`� Number of'lines `____f• -• ------------Length of each line-_ __ - - -J� ---.Wid#h of trench- 1 �- Type of_filte materiaL__ �G ------Depth of filter material___- TI---- length______-_�� ---- 4 ` G Seepage Pit: ; Distance to nearest welly___________________Qistarsee from foundation_µ___..__-_.Distance to nearest lot line_____---_-___.__ p r Size: Diameter-------------- ------Depth--------------------------------- ❑ ` C �", Number of its.---------�--- -.--Lining material__•------------------ ,. Cesspool: D-+stance from nearesf' well --------Distance from foundation_____________:-_-._.Lining rmaterial__..__- _____--:_-. ❑ Size: Diameter Depth -- - -------Liquid"Capacity------------ gals. t ' ._ .Distarice from nearest well----------- ` ---------- g = : Privy: Qistance from nearest building Distance to clearest lot line--------- ---------------------------------- _B �V �`1F17t tP �T VM_(77--- - - I Remodeling and/or repairing (describe):__._---- aT� -- ----- �� 2Q ---------- ----------- 1,fv�.tEr�---------F 1 ��--�-----`�-'-TH-•- RG�cK-� �� K ' �Q -------------------------------- �` r`'�-------��-------..,��t---------fir----_-�'-=-------------------------------------------•--------------------• ------------------------------------------------ , ! ------------- ------------- -- --------- - - ---------------------- --- _ h ---------•--------------- ----------------------------------------------- I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .e ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i - — NIRA--d1r*Q"--C+O+ fr�§i Signed k `BY:----------------::------------------------= ----•------------------------------------- ----------- - - (plot plan, showing size of lot, location of system.in riletion fo wellsiFbuiEding`s ietc:,,canl8e placed on reverse side. FOR DEPARTMENT USE ONLY } � APPLICATION ACCEPTED BY----•- ` -Q_ .__ ------- ----- DATE ,,_,......._ -- REVIEWEDBY-------------------------------- ---•-----------•---------------- -----------------=r"...3-------------------------- ------ DATE_ .--------• ----------- BUILDINGPERMIT ISSUED---------- ------------------------------------------- ----._ DATE------------------------------------------------- •--------- t .. Alterations and/or recommendations------------------ ------------ ---------------- .. _ -------- •--------• -`- --------------- -- - ` ---------------- --- ---------- ---- - -----------------------•-_•----- t----...-------------------------------------- ------------------ . ._—v t --- '------ ------------ -------- -- ---- =-----Z-----=-------- ------ - ' ----1---.--.-- /p -------------------------------- rDate------------ - --- ----------------------------- - —--- ----------------------•------ ---- �- --- FINAL INSPECTIO SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California- � Manteca,California Tracyr California E5 9 REVISED B-59 3M 3-'63 F.P•CP• c5