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' APPLICATION FOR SANITATION PERMIT Permit No. ...... �1 (Complete in Duplicate) V� a Date Issued,--- A ssued -_`�_� 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 IC ompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------------7f11----------��------ -OP-2-6----------- -------------------------------------------------------•-• - ---- ------------- ---------- Phone-- Owner's ----------- Owner's Name------------- C,/l- ------ Phone 0.5.0_ - - - Addresszai_qq :-�' l P --- ---------------------I-•-------------------•--------- ----- -------------------------------------------- }�� .- � Contractd� J_ r a Installation will serve: �Re�fdence [K artment House ❑- Comme tial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number ofii n units: --- .- Number of bedrooms - g-- Y :_"Number of�baths - Lot size 1� 7 Water Supply: Public system Community system ❑ Private [N,'Depth,to Water Table -4rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ S' clyr-L m 0 Clay Ldam ❑ Clay ❑ Adobe Z/Hardpan ❑ Previous Application Made: Yes ❑ No [", New Construc�t.ib�n: 4es�No ❑ FHA/VA: Yes ❑ No E< TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or°cesspool permitted if public sewer is available within 200 feet.)4.,r h Septic ank: Distance from nearest well---- ---Distance from f undation-_./0__-_ _`Material--- No. of'com artments-----..-----leof........Size-_-t,�____XLiquid depth—:N. "-----------Caacit Dispos Field: Distance from nearest well Distance from foundation------- ----.Distance to nearest lot lin Number of'lines-------------'aE `____-.--__Length of each line------ 'r-� Width.of french_._____-------. .� r----------- ! Type of filter material------ ._ -C?_e�:-.f_<$epth of filter material-__.�_ -----------Total length----------------T I Seep a Pit: Distancelto nearest well___.-,_ ___Distance from o¢dation----_J-.Q..___PDistari�6 to Pnearest lot line---- .----- -Linin material- _ _ £_( (Size: "iameter___--- De th-----.----__ ' r of pits- ------1�---=----- g F ��#r �-� � �-�- P �'-'-`S------------\ Cesspool: Distance from nearest well-----------------Distance from fora#ibn---.-.-.-_ ---.-~Lining ma#erial------.-____-----__.-______---------. . ❑ Size: Diameter----- ---------------- --------=------Depth------4=,-------------------------------`--------.Liquid"Capacity--------•---•--------------- gals. Privy: Distance from nearest well------------------------------- Distance from nearest-builair c)--------------..---__---------------. El Distance to nearest lot line--'"' ---------------------------- ----------------------------••-----:.a------------ ----------------------------------------- Remodeling and/or repairing {describ'e):----__, -------- ----- ------------ •------- ------------- aj��_ �_-—- ,Z ---------------------------------------------------------!---------------------------------------------------- ----------- --------- --------------------------- -------------=----------------------------- -----------------------------------------------------•--•-----•-- --------------•---------------------------------•---------------- ----------------------------------------------=----------------=-------------------------- -----------------------------------------------------------••-------------------------• ------------------------------------ I hereby certify that I 'have preplored this application and that the work will beAoni-in"accordance with San Joaquin County ordinances, State laws, nd rules and regulations of n Joaquin Local Health District. �r a � c -_ -_ h---------------------------------- caner and/or Contractor (Signed} ---------------- _ r " ---- --- ( ' / I BY: -------------•---------=---------------------t------- (Title) f (Plot plan, showing size of lot, location of system in relation to wells, buildings,,efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DAT ......,. _.� APPLICATION'ACCEPTED BY --------------- ----------------------------- E-------------- --`�' REVIEWED BY - -- - ------------------- -- --- - ---------------------- - --------------- ------------------ DATE BUILDING PERMIT ISSUED.----------------- ---- ------ - -------- ------ DATE--------1l�( ---------------------------------------- --,.- - •........,.,. t�-----f--- Alterations and/or recommendations:-- -------------------------- --`'r' ------------------------------------------` t 1 �-�R� i -:per------------------------- ----- --- ------- ------------------------------ /-------/r- r��-- ----- - --•--------------•--------------------- -------------------------------•----------- --------- -------------------------------------------- ---- ice` .. _ tai - FINAL INSPECTION BY:'-,----- �-i-7!-t7-It)- ------------ ------- Date---------- 3 - , -- -- -- ---- --------------- ------------------------- I `! SAN JOAQUIN LOCAb HEALTH DISTRICT f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i� Lodi, California Manteca, California Tracy, California ES-9-2M , Ravisea 1.5i!F.P.co.