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FOR OFFICE USE: --------------------------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ��:._ ` - -- ------------ ----------------- (Complete-in Duplicate) This Permit Expires ] Year From Date Issued Date issued=_1.7`_��__ . ------------ .- --------------- Application is hereby made to the San Joaquin Lotal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._-) C�G-_.. JJa-J�l--�/-�......--�1'k--------- �- ---------------------- 0a, ------------- - Owner's Name------ e� � fl ----- ----- --- -------------------------------------- Phone " 17 Address._. ! _r. �-. �3 _ - ----"'`".," _./C-/� �,.----- Contractor s qN __ �/ ~d DD"� � Installation will serve: Residence-�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ \Other ❑ ` ice'` Y' Number of living units: --- i - l `v Number of bedroom Number of baths__ Lot size /_.0P_ .. ©-.___�...__��__-.__ y� Water Supply: Public system ❑ Corrirrlunity-system❑ Privateepth-.to-Water Table _ _ ft 'LYes ' rCharacter of soil to a depth of 3 feet- Sand ravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobardpan ❑Previous Application Made: (If yes,date..............._.. ] No �ew Construction: Yes�No ❑ FHA/VA NDSPECIFICATIS-.'`TYPE'OF'INSTALLATION (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ � A __.___._.Material � iC�T Septic T k: Distance from nearest well�Q .._ ___ . Distance from foundation __ tt _____. No. of compartments------------ ----Size---_-_-------------- -----------Liquid depth_--.---- -_.__-. --___-._Capecity`as �Gea s Disposal field: Distance from nearest we11.0.__-----.Distance from foundation/,O.............Distance to nearest lot li`�------------- Number of lines____ ___ _________________Length of each line__-_ __.________._.___.._.Width of trench., �________..____.._ _ \ . Type of filter material _ '_ "Depthof-filter rna#er�ai_=� 'fir----z5fal length__ Q__________________________ f Seepage Pit: Distance to nearest wet#____.-_______________Distance from foundation--------------------Distance to nearer# lot line_.__________..._ ❑ P ------ g � t�.1„ i-- ize Diameter ----•-- -------------.Depths -`------ --- ------ ' Number of its.. (...__._ Linin mater a'l '^_� G.- S Cess ool: Distance from nearest well ----------------Distbnc t } q -. . P is from foundation_________________ __Lrning material__._._.:.._.__.______-__._.__..._..._ 1 ❑ Size: Diameter. ----- Dept h---------_ ----------- -------------Liquid Gapacify-- ------..gals. Q ----- - --- ------------ Privy: Distance from nearest well________-________ ------i---------------------._Distance from nearest building Distance to nearest-•Iof,Iine_------------- - =--- -—-- --•-- -------- ------ Remodeling and/or repairing (describe): - �- ---- - ------- --- ------� -- ---� - -- ---- ---k-----------------------------�---- ----- k_ �/ �L�/ k 9 / P g ) �+r� 'L /r � '+LC ----- _ lI - ---------- ----------------------•---------- ------_--------------•------------------- -------------------------•---- --------------;_� -- - ---------------------------------------------------------------------------------- -- ----- ---------------- ------------------------------`----- ------------------------ ------ ------ ---------- ------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health'Distric_t. (Signed)------- �'` ��/IS---- C- ��T/ 1----------------- _ -iihd/or Contractor) �. _ _ �.r - B --- ----------------= =------ y�a K Tif r .. Y=--------- - �-, ----- - - --- - -�--- -- --- - 1.r ) � - (Plot plan, showing size f lot, location of syr+em in re o webs, buildings;;etc., can be placed on reverse side). ..FOR DEPA4TMENT-USE-ONLY i x � APPLICATION ACCEPTED BY---------T, --- ---------------------------------------------- ------------ -------------------------------1--------- DATE-- S- Y-- W----------------------- REVIEWEDBY------------------------- -------------------------------------------- -- -------------------------------- --------- DATE-------- --- ------------------------------------------------ BUILDING - -------1-------- DATE-------- ----------------------- ------------------------- . Alterations and/or recommendations ndations:------ - -------------------------- - - -------------- ---- --- ------------------------- ----- -------- ----------------------------- ---- ---- — - -- ------mac-----•- - ----------- - --• - --------- --------------------- -- FINAL INSPE N BY:. 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 E.H.9 2M 1.67 Vanguard Press 5 i {