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-FOR OFFICE USE: ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT ' Permit No. ..................... .......................... ----------------- (Complete-in Duplicate) J ------------------ This Permit Expires 1 Year From Date Issued Date Issued llf f/~ � Application,is.hereby made,to�the`�San-Joaquin Local„Health District fora-a, the-work herein described. This application is made in compliance with County Ordinance'No. 549, t1 JOB ADDRESS AND LOCATION -��`.�'I -- \_-_CAI-hIL --- '-- Cflmn � aN6---- R �----------•------------------------ Owner's Name:-Lu _ IPhone__I�ION - --------------------- I Address ..-------•----------- --..--------------------------••----••------• fContractor's: Name ±-----•---•-----------•--•-• -------------- - ----- ------- ------------------------------ ------------ Phone-------------------------•------- Installation will serve: Residence ;5 Apartment Hous h Comi ercial ❑, Trailer Court E] Motel E] Other ❑ Number of living units: __L_._ Number of bedroo;s __.- Nlurrlber of ba;hs _0�._ Lot size ----- __N_ACR!� V p $ Wafer'Supply:' Public system ❑ Community system ❑ Privete(''� De th to Water Table . p ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Saindy-LLoam ❑r Clay Loam ❑ Clay Xj Adobe ❑' Hardpan Previous Application Made: llf yes,date----------------- . ) ,No* New Cons#ructi n: Yes No ❑ FHA/VA: Yes ❑ No TYPE-+OF„INSTALLATION AND-SPECIFICATIONS.. • -• � ,�,� (No septic tank or cesspool permitted if public sewe s available wit00 feet.) i s -� � It ©E - w Septic Tank: Distance from nearest wel�__ 0------Distance from foundat on____� _________ Material.. ----____ c� No. of compartne ments-- ------ .. $�ze �a =��x Liquid depth------17------ --------CapacitY--- �------ f Disposal Field: Distance from nearest well.____S8_..._Distance` .rom.,foundation___ __ ____ ._ y __._.Distance to nearest lots line_r12&�.... �i �� i Number of lines._..�------------------------t1 ngth YW ofJ,ea2`h-Iine-_R{V_---------------Width of }rench---,qt/J_-_---.------_-__----- Type of filter materia _Depth Yp p Cfilter material . Total length- 0-�I - -------------- Seepage Pif: o�. f Distance to nearest we11_..._................pistancetom foundation_________.____...__ Distance to nearest lot lin e----------------- ❑ Number of pits.-- ---------------.._Lining material---.-�-------------- Size: Diameter------------------ ----Depth---------..------ Cesspool: Distance from nearest well ------------- _DistkntJ f orn-Jounn:dation................. . Lining material__._.._-...._-_.____.____.__.____._ ❑ Size: Diameter- -- ------I-- --- ----------------Depth - - --- -- ------Liquid CapacitY--- ------------------------gals. Privy: Distance from nearest well____---_-------------------------------- ----....Dist anca rom nearest building-___.____-_..________._______.__.._._. ❑ Distance to nearest lot line. --------------------------------1 ; Remodeling and/or repairing (describe): ------------------- /"� a.=,`----------------- . I - --------------- •----- -•---- ------------------------------------------------ ------ ------------------------------------------- ------------------•----- ---------------------------- -- I hereb certifythat I have prepared this a lication and that the work wili,.be done in accordance with San Joaquin Count 1 ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. ! (Signed)------------- --------- -- - - ---------- ------ - -'- r l ,.,..,,._ _ �. - : ..--- --- - --- -jOwner n�r�and/or Contractor)-,�,. BY: - -- -------------- ..... (Title)--------- - ----- --------.. ---- ---------------- (Plot plan, showin Me of lot, ocation o system in elafion to wells, bui gs, etc., can be placed on reverse side). 9 FOR DEPARTMENT USE ONLY j r APPLICATION ACCEPTED BY - --------------------------------------------- --=----------- DATE--------- --- - ---- . - -------------------------- Yl REVIEWED BY - ------------------------------ ---`------- .........• DATE--------- 3 BUILDING PERMIT ISSUED-------- -- ------------------------- {" DATE Altera#ions and/or recommendations:- - --- ---- •-----... -•----------------------------------------------------------------------- ------------------------------------ ------------- -------•-------- -----------........ -------------- - — ----------------------- --------- — — - -- -•--- - �� l ---�` FINAL INSPECTION BY:..---- - "s`f Date........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfaielten Av 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,CallfOrn a Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press