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FOR OFFICE USE: -------------------=--- ------ ------------------------- - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. � . (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 and install the work herein described.` This application is made in complianc with County Ordinance No. 549. "/,j X JOB ADDRESS AND•LOCATION------------ M c`�f-----1'r - ---✓-r--" c�--- :-------�_U _r_L)Fr----------------------------- Owner's Name-pp--�•J{aTHUF----- _�_�..�-j-�f�1-------tis.fv"�rmE--------------------------- ------ ---------- Phone----------------------------"___---- Address------------l-TiF:-----qn" .....B Q-X------A0_Z3-----------Coo-1413� rscakoko -- = ------•---------------------------- -0 ------ ___------ ) 1 Contractor's Name--- 7___-_�EPTZC_." 5.ER 1-C'E--------_r_V- i 4-4K Phone Installation will serve: Residence) Ej� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of _- _ _ _ living_units:.___I____,Number of of Number of baths _1Lot size .--f Q__X-.-.-CS ________________________ ;-4 4 F t _ . Water Supply: Publ � system Qi Commeinity system"_ Privat ❑ Depth,to WateTableYsft. 1 Character of soil to a depth of 3 feet: Sand�❑ Gravel E] Sandy Loam E] Clay Loam v Clay ❑ Adobe ❑ Hardpan [� Previous Applicatio&ade: [If yes,date--------------------I No F(eK New Construction: Yes a--No ❑ FHA/VA. Yves E- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: } �.�(No se tic tap n or.cesspool permitted-if public-sewer is-available-within 200 feet.) Septic Distance from nearest well__.-ws _-_ -- Distancefrom fou�/nd�ation__ 1 -----------Ma �er',alG __-___.., No: of compartments-----7fSizee x.— .L -derpth:_ Capacity--- ? d__ ------- --------- _ ' - qu + . �� Disposal F;eld'i Distance from nearest/well-_-.%50_-._.Distance fro l foundatlon__fQ_______--- Distance to nearest lot line________.______ Number of lines---------- ________ Length of each line_______ Q_______ Width of firench,__.- --- ^- �j 1 .x---- p� Type of filter material____/'�Q. _Depth oCfilter material____..�Q__ .___Total length___-___.____________ ,_____.-___ (� ��______.Distan to nearest lot line-----��?_-_�___--_ Number of its__________________�� ----"""Distance from foundation____ _ _ Seepage Pit.. D�smber t f nearest.-- Lifting material__RaC�_..Size: Diameter -_x--.9-_ Depth p -----/:Z=-------------- Cesspool: -- ----------------------Cesspool: Distance from nearest well------- _-.---._Distance from foundation--------------------Lining material-------.._.________-__-__________--_- ❑ Size, Diameter-------------------------- --------Depth--------------------- --- ------------------- ----Liquid Capacity-- -------------------------gals. Privy: Dist�nce from nearest well-__-__._-__________________________ Distance from,nearest building-----_---__-___-__-__________--__---_____- Distance to nearest lot line-- -- -- ------------------�--.- ----„------------------ ------------------------------------ ---- ---------------- Remodeling and/or repairing (describe=--- ------------ -� _- -----=------- --------------------- ----------------- ----------------------------------------------------------------- •----------------- ------ ----------------------�,� .•.3.t-----�# --------------- -------•------------------------------------------------------------------------ -------------------------------------------'---------------1-------•---------- --------------------•-•--•------------------•----•-------,r = -------------- " - - ------------------------------------- -------------------------------------------------------------------------------------- -__,` �. 1 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-of,the,San.-Joaquin Local Health District. (Signed)- - - - ------------------- -- ------------Owner and/or Contractor) i t . _ BY:,--- ----U:--------r---------------_--_-"--_-- _----—: -----:_ - l - ------ ter_._(Title)-- - ----- ---- ---- - .._ . ------ -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY---------- --`--------- # ------------ DATE---------3--Y--- ---- _--------- REVIEWED BY------------------------ ---------- --------------------- ------------------------------ -------------------------- DATE---------------------------------- ------- :. ----------------- BUILDING PERMIT ISSUED----------------------------- ------------• DATE------------- ---------------------------------------------- ------------------------------------------------------ Alterations and/or recommendati r7---1-----H--Y?-'`-_-._------N--E-----'-1--'1-t--o--•'i-r- --=-:-�--2---1--S-T---H"---------------------__------------------------------------------------------ t ------------------------------ ----------------- tP 677 M ----� 0d l `rR _i --------------------------------------- -jr= CN T�' ---------------------------------------- ---- / ------ -------- ---------------._--------- - -------------------------- ----- ---- --- - ----- -------------! ---------`------------- ----- ----- - FINAL INSPEC --- ------- 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 Tracy,California r.P.CO.