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} FOR OFFICE USES . �� g� APPLICATION FOR SANITATION PERMIT Permit No./r ---- --------------------- --- ------- (Complete in Duplicate) - _ This Permit Expires 1 Year From Date Issued Date.issued 1c1___.g>._-�Sa ! Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. 'This application is made in compliance with County Ordinance No. 549. LCATION_ - ----------- � An� -JOB ADDRESS AND - ---- ---- - - - -- ---- ------- Owner's Name----�OR-WI-Al. �-��f-E - -- =.- �---- ---- ----- -- -�-..Phone------------------------------------ A -----------•• -------------------- -------------------- Address - -� 6RAN� '!8-1W------------41 TC _ ` -Cotactors Name F _..._. 1-7-------- ----------------------- - ----------- !Phone- ----. ----•---------•-- Installation will serve: Residence g—Apartment House ❑ _Commercial ❑ Trailer Court ❑ Motel ❑` Other [I Number of living units: _/____ Number of bedrooms _ Nu� -0e't)f baths -'7— Lot size __. £ Q0----_13______________________ Water Supply: Public.,s stem,. ,� Community system Private �R, e th to Water Table l-4f-- ft[ PP Y� Y ❑ , Y Y ❑ i 4�u P I Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy�Loam ❑-.9ay,Loam ❑,,,,Clay,❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,da#e-_-_--____,`?^__ _) No New Constructi_on:-.-Yes [E— FHA/VA; Yes ®< No ❑ 34 w t.. 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No-sopfic;tank�-or_cesspool_Permited-ifipu6licsewerhis.ay.aila6le,within-200�fee+.) - Sep#ic Tank: Distance from nearest well----��- __Distant from foundation__.f_f./___.____.Ma1teriaL. � rl �x/P*71 1_i uid de th____.j�__. lCapacity—1 _ No. of compartments----- ----- ------------Size--- --- -- - ---- --- q P. 7 ------ - Disposal Field: Distance from nearest well_ 57---Distance from foundation-----lc--------Dis+anceito nearest lot lire-................ ❑ Number of lines___ -.-,-__;____________Length of each` line_ _a' �: Width of trehch...._F�z. _,_____ r G Type of filter material?0_C.K----Depth of filter material ____ _ ___________Total length--------45_n_________________..__ � Seepage Pit:; Distance to nearest well-------------,--------Distance from foundation—--------------- to nearest lot line_________________ i ❑ - Number of ------- - -------Lining material._ _..:�---------Size: Diameter,-_---- �--Depth --------------------------- iq , Cesspoo(. y`). " ,Distance from nearest well-----------------Distance from foundation.__ .Lining material-------------------------------------- El ..__.______ _ _.___.____.______- !u ❑ Size: Diameter._ Depth.__ ___. _____ Li uid Ca aeit gals. a i q P Y------------ -- Privy: + t Distance.. rom nearest well--------------.---- ----------------- ------_--.--Distance from nearest buildin ---------------------------------------. t i ❑ Distancelto nearest lot line-------------------------------------- ---- ------------------------------------------- -------='----------- -------------- Remodelingand/or rep describe]- ----------------- -----------------------------`------------------------------------------ -------------- -----------------------------------•--- F f ------------------------- --------------------------------- - ---------------------------------------------------------- ----------------------------------------------------------- ------------------------•--- ------------------ -------------•------------------------- - I hereby certify that I have prepared this application and that +he 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) 71 T ---------------------------(Owner and/or Contractor) By: � _ = ;(r - . """"Plot plan;showing size of lot, location of system to relation to wells buildings, etc., can b placed on re-verse-side}. i y(� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY (.i '�-_-_______________ ___ f 11=2-6 #, DATE-------------------------=------------ REVIEWED BY---------------------------------- ----------------------------------=-------- = BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---- -------------------------------------------------------- 1 Alterations and/o� recommenda+ions: - - a _ _ - I µ -- - - ----- _i94lt `- V " .1 , - ---- ---- ----- ----------------------- -- --- - ---- -- ---- ------- --- --- -- ----- --- -------------------- --- ----------------- ------------ ------ ----- ------------------------------------------ FINAL INSPECTI -- ------ 'Date--------L.�-_`.` ---------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeftan Ave. 300 West Oak Street 124 Sycamore Street - 205 West 9th Street ' Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. r;.