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FOR OFFICE USE: ------------------------------------------------------- fes__. 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 compliance with County Ordinance No. 544. JOB ADDRESS AND LO ATION- �� L I ----DE------ -�------R.D-� ------------ ----MAW Owner's Name.---• _---•--Jbi}-TLE. __..... Q - _ = Phone Address_______________ -L111......----1? .-----I�UF---------: 7 ` :------------------------------ Contractor's Name---------- -+ -------- -----•----------- ----- - -- ------------------------------------------- Phone------ ---------------------- Installation will serve: Residence ® Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: I----- Number of bedrooms -3.- Number of baths-2---- Lot size -_ACAEEA6 ------------------------ Water Supply: Public system ❑ Community system ❑ Private .K Depth to Water Table _X_ ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Saanndy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ H�arrddpan ❑ Previous Application:Made: lIf yes,datte�--_- _ )N Construction Yeses ❑..SHA/VAS Ye�L�l..�0 0 I TYPE OF INSTALLATION AND SPECIFICATIONS: A i (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) i I — �- f - + Septic Teqk: Distance frgmanear._est„well_._ _+ _____Di`sta ce from_foundati_on_;;. ry. ._;__._... Materi i __ /Yy�/---�- rL�Jj No. of comparments.----- f Size._ ___r !.l_ - _��-Liquid depth-----� .--"�------Capacity--- .f ,J �i �1 /._._.._._.Distance to nearest lot ling_- Disposal Fie4d: Distance from nearest)welf....��-___-Distance from foundation___ __ ._ Number of lines_---_-_.2r_-- _.------Length of each line__ . _---.-_.�r-.. Width of trench_._._ ____-__-___----_-__ Type of filter material_-+ 024K ".Depth of filter material .._..(_ ._. Total length _--__._��__________.^�_.._ —nulff -�. ... Seepage Pit: Distance to nearesf well' _.::...__...`_"-Distance'from' oun at"on':' -_�� ancefo nearest lot line_________________ Size: Diameter- ----------- - . th---------- --------------- I ❑ Number of_pits------------------.--Lining material-------------------- � - Depth Cesspool: Distance fironi nearest well ---- ---------Distance from foundation--..----.-_.. L.i g mater'sal-.-.---..-.----..---___-_---_.--__--_ I ❑ Size: Diameter. -- ---- . ---- __..Depth---------_----------------- (Liquid_ CapacifY------------------------ I. .-..gals. I - �"i Privy: Distance from,nearest well------------------------------------- -----------Distance from nearest buildin4.--_------------------------------------ Cl Distance to(neares} lot line------- ..._ ---- `tI 1 ., Remodeling and/or repairing (describe):_ -----TN-J'- � - _ ---f- s- _f-,, _ 1 t_ --------ies i_ l .' Cx t�+`� C x:a- _ i.ap s"Al---------oviI-- ---------------------- ---------------------------------- ---------------- J ----- ------- -------------------------------------------- 1 ----------•-------------------- -,�_ �. ------------ I hereby certify that I have prepared~+hiss aoplicatidrir�.and that the work will be done in accordance with San 'Joaquin County ordinances, State laws, and r les and regulations of the San Joaquin Local He�lth District. , t- ..-.-_.--(Owner and/or C� ntractor) (Signed) . =- �__. - _ ., _ -`�- g ---(Title ---- ----- -------- - ( ] ). (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side h 3 FOR DEPARTMENT USE ONLY ' �� APPLICATION ACCEPTED B �Y----- -R_� ---------- -- --------------- ----------------------- ------------- DATE------ �`------------- REVIEWEDBY----------------------------------------- -------------- -----------------------;-- ----------------------------------- DATE-- --- -------------------•------------•--------------- BUILDINGPERMIT ISSUED------ --- -------------------- ---------- -------------------- --------------------- DATE--------------------•---------------- ----------------------- Alterations and/or recommendations------- ------------ -------- -------------------------------------------------- ------- ----•------------------ ----------------------- w-__---c9� ... . - -- -- ---------- ----•--------- ----------- -- --------- -- -------- ------------------ _- - - . ---------------- {` .................. -------- --- ----------------------- -------- ------- ---------------------------------------------------------- - ..-----_._....--_ --_ __ _ -- '__....- _.-.-----------------.-...---_-:--..--_.-.-..-...._.------_.._-----_.----.---------.------ r -- - Date.... � ----�5.... F ---------------- FINAL INSPECTIO Y:._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Maieltan 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 F