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rUK UWCE USE; -,r• - --•-•------------ -- --------- -------- -------- ------------ -------------------------_ -- --------- APPLICATION FOR SANITATION PERMIT Permit No. � --..__,.......... (Complete-in Duplicate) - --- - -------------------------- ----- This Permit Ex lies i Year From Date Issued Date Issued�1-:!ag k_1 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. 549. JOB ADDRESS AND LOCATION-..__ - `,7 ----- -------- C L. t Owner's Name-------------- ----------- -�L.L = -----•------------ I ------- Phone --•---------------- Address------�! ------'-">- _------ T _t _P. _LS_E...- p•-------------• c. c :_ Contractors Namow _'_V`` _,: ....._._.. :------0-w-6 - ------A -•- le o R9t3EFl.NS_._ Phone----- :, Installation will serve: Residencd`5A Apartment House 'E]❑~'}C`"'mmercial Trailer Court g � ❑ ❑ Motel ❑ Other ❑ . s: __ �_._ Number of bedrooms.- =t- Number of baths ------- Lot size --_ Water Supply,- Public system.Number of living unit PP Y� i y m.❑ Community system ❑ Pri`+e ❑ Depth to Water Table 3S_ ft Character of soil to a;depth'of 3 feet- San([:] Gravel ❑ Sandy'Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan j Previous Application Made: {If yes,datd_.----------_---- - } No New Construction: Yes Q No FHA/VA: Yes ❑ No TYPE F INSTALLATIZ7N AN SPECIFICATIONS: (No septic tank orceoiil permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well........... ..Distance from foundation-----____-._..._ terial ......___.-___.__..____-._ is T!�C No. of c'orn.partmenfs-------` --------- ----------- Size -----------Liquid depth;. -------Capacity--•--- ------- -------- Disposal Reid: Distance from nearest ell............... t istance from foundation-----------------._.Distance to nearest lot line_______.-_____.. Number of fines. Length of each line - Width of trench Type of filter mafienat_________ =<---Depth of filter material__-._-____ -. ---Total length --------------------- Seepage V lA 1,J �f 'r�i 9 ----------•--------- �1 P 9 isfiance to nearest well.'4_��---_-----Distance from foundation----/(]_._____.Distance to nearest lot line-j4577-.. i y ee a e Dumber of pits-_. _.,�_._-- N Lining material_9-Q--G- ____ Size: Diameter. _ _ W i l � � -----Depth- ---- -3-------------------- Cesspool:- ('`-Distance::from nearest well ..-______-__._Disfiance .from foundation . - Lining material________ _____________------------- Privy: __________ _ Y 0 Distance: L { ❑ # ). Size: Diameter- -- ---------- --- -------- -----Depth----- ----------- Li Liquid Capacity i ------ --------------------- 9 - ------------ ------ --gals. r Priv i from nearest well...._.__.-_------d--------------. ___ Distance from nearest building F e t Distance,-fa nearest lot line_.__ l - ----------- Remod�1i Ig and/or repaFr4ng_(describep: ---- ---- w ------------------------------ s _____________-------________________--______ ' I ' -----------,'------------:------------------------`---------•---------------------------------------------------- ---- --------- I hereby certify that El,have prepared Phis applicafion and that'the work will be done in accordance with San Joaquin County ordinalices, Stafe,�laws and" ues.,an .re ulat'ons�o�f &e San Joaquin Local Health District. (Signed) i _ .2- i -' �•'�a� -i--r. '. �+.p-a,- ......:,�m� ^., nner.andZo Contractor) sY ' - { w - - -t-- ----- - Title ti..- ----- �, r (Plot plan,Fshowin'g size of lot, location of system in relation to wellls, buildings, etc., can be placed on reverse side). FOR DEPARTM(I T USE ONLY APPLICATION ACCEPTED BY- 1_ Rid ; �� ----- ------------------------- -------------------------------- ------ DATE_ ----- ------ 67 REVIEWED BY `,= -- - �- -- - - ' - ,., -- ---- ------='`--------------- DATE---- --------- � � ' _ _ _ i ,k. ��, --------------------------� ---p- and/or recommend - ' ---.--DATE- Alterations i-r P r f- --- ._.----- _L '---.__ --- ,,. ations:--- ---------- - - - - --�--- .. =, - - ti -----•-- , ----- --- ---- ---- ----.. � j - - ------ - - ----- . FINAL INSPECTION B C>afQ r 1�1-� Date_. — b SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West 9Th Street Manteca,California .E.H.92M,1-67 Vanguord Press �' Tracy, California