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FOR OFFICE USE:----------------- _._ APPLICATION FOR SANITATION PERMIT Permit No. .>� ' i ------------------------- --------- -------------- (Complete-in Duplicate) Date Issued.-- -= P�-----.--- -.••�P, .............._.__- _____ -- ""'" This Permit Ez ires'1`Year-From-Date Issued Application is hereby made,to the San Joaquin Local Health District-for a%perrrtit to construct and install the work herein described. �W---•This application is made in`compiiance-with County Ordinance No 549'. --- JOB ADDRESS AND kOCATION 7-17 o-------- ------------------------- . ------� C/ Owner'I's Name-------- `u-- ------ . --- ------------- ------------ Phone__,3;73.e_AP,/__r-_ ----- r . I Address ----- --------------------------------------------------0 A) :5 --•---------------------------------------------------------------------•------------- Confiractor's Name 1 1 6__; [ ------5 O /V e`� ------- ------------------- �` ®{ Phone I Installation will serve:'fResidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of liviN .0n i'-units: _. I .. Number of baths _%--- Lot size _ - .7--? -7- y{ g �_-.- Number of*bedrooms�__ i Water Supply: Public system ❑_ Commbnityrsystem E]—Private X7Dep+to W;er Table 7,57--ft CharaEter of soil to a d�pth of 3 feet• Sand Gr vel'❑ Sandy Loam ❑ Clay Loam!❑ Clay ❑ AdobeV Hardpan ❑ r Preyious Application Made: (If yes,date_ _....._ .--__ l NoNew Construction; Yes ❑ No FHA/VA: Yes ❑ No1C� TYPE-OF INSTALLATION AND SPECIFICATIONS: 1 �[ (No septic tank or cesspool permitted if public sewer is available within 240 fee d r € Se tic Tank: Distance from nearest well-- p - _-__Distance from foundation_,�.Q..____.___.Material ... No. of compartments Size_ � �•.IS_.�'X-��-._--Liquid depth---.�-- �-��.------ Capacity,lZO.__O Dis o al Field: Distance from nearest well...`S .. D , ;9 .r T,tt t p �^ +f' F � i , Distance from foundation___ �_ e Distance #o nearest lot line Numbe"r of lines. w_ -_ .__: Length of each line.- - I--.Width of +rench..--- _ �(___._..____.__. � � l Type of filter rriatenal___ E?epth of filter material___..[-._ -___ .-.Total length___..___. ._--_-{ j { r Seepage Pit: Distance to nearest well.-I.00-------- istance rom undation__:____________-. Distance to nearest lot line_,.,— -.. Number of pJs:.46_��.__.-----4i—ffing material.-�- -- Size: Diameter_251cc,..._...-..--Depth---_ �#---------------- 1 1"i t\'). � '1-F l I Cesspool• Distance from nearest well ------ ..-.--.--Distance from foundation.l-- Lining material,-- -------------------------- �?rk .cam k -i uicl C`— a i — ,5i `" --------.gals. Size: Qiame-ter_ = De th R F c ❑ '_y-, p q ty aP _tY, Privy: Distance from ne rest well. . ..............I------------------------------Distance from nearestfbuilding____J.---------------- :--------------. Distance to,ilearest 'lot.line .._'--- ------ -------- `--; ==m fio--- --"�" -------------�--------------- �------------ ......... RemodeIingrand/'or repairing (describe):-----Z. --- :s--_ ~ --------- -- ----- ---- -------- -- -----------__-- � � - W. 1 `tes�-------------------- --- r ; ----------------------- - -------- -- - - : I rherel?y certify that I,.ha. _PrP pare _thisya licat.ion_andV ill_be done_in_accordance with.5an Joaqun.County ordinances, State laws, and les and r gul ns of a-San Jealth District. d c- (Signed) ` (Signed)----------------------------- -- -------- ........ -- - -----• - ------------ - (Owner and/or Contractor) B {Title} ,.. y•----------- ----------- -- i - - ----- ---- - -----: --------- m plan, showing ot, location of sys+em in relation to , , etc., can be pia don reverse side}. ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------- _-`Z.%'-: - ___ . i.. DATE - ---------------- REVIEWED BY----------------------- -----------------------------------------------------_---------------- ------ DATE---------------------------------- ------------------------ BUILDINGPERMIT ISSUED-------- -- - ----------------=----------------------------------------------- ----------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------- --------------------------------- --- '---------...-------------------------------- ------------------------------ --------------------------- -------------------- ---------- --- FINAL INSPECTION BY:..__ \�4` _ 2 q 1 �i�^�lJ ' Date- �J C7� ` 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I' Stockton,California Lodi. California Manteca,California Tracy,California ' E.H.9 2M 1-67 Vanguard Press e•