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FOR OFFICE USE: J x- Y__ , -- -------------------._t_� u 1.----_ ?�i APPLICATION FOR SANITATION PERMIT �} G(` Permi+ No. ............ (Complete in Duplicate) - - �,. _r •.•-- �...�.. � __ .---- ._._ Date ISSUE ---��/��/ ------------------------------------------- 1 Thls Permit Ex tree 1 Year From•Datia 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._549. i JOB ADDRESS AND LOCATION----:Z175-11---------- S PS �� 'r -•--•----------------•-•---------------------•---- -----------• -------•--------•------- Owner's.Name--__!�_)--0 ................ r--------------------------------------------------------------=---------- Phone----------_-----------------•-•--- Address--------'5� � = ------------------ •--------------- -----------...... -------------------_--------_ } ---------------- Contractor's Name-------` K ---- s yi__ E`r ' --------------------------------------------•-------------------------. Phone..C. _.. Installation will serve: Residence C. Apartment House ❑ Commercial ❑ TralileT xCOurt ❑ Motel ❑ Other ❑ Number of living units: __ - -- Number of bedrooms _3___ Number of baths ._Z- of size ... --•---------------- k ` Water Supply: Public system ❑ Community system [, Private ❑ Depth to Water Table -------- ft. Character of soil to a depth=af 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam'❑ Clay ❑ Adobe C& Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [& New Construction: Yes ®; No E] FHA/VA: Yes ® No E] '1-�-+• TYPE OF INSTALLATION 1AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well_'_--t11 _►'1:(z Distance from fogn—dation,-___l_Q.___- .Material__C 1t1_C_F,L_T_1*.__.__ No: of compartments-----04, _ --___Size_ - --- •-�---Liquid dePfh______ _ P Y••-•------'-- Disposal Field: Distance from nearest well----IA.O?Vle.Distance from foundation------1.6---------DisFance,to nearest lot iiia___ ._______. [ . Number of lines---------�----------------------Length of each line___ 4� dth of trench___. _ __._--_______________ Type of filter material__--r--0 +-------Depth of filter material___".-1-_��___'__Total lerigfh:--:__ __�Q�__________________ Seepage Pit: Distance to nearest'well_-___...4__-- ^Distance from foundation._a------_._ _.Distance to nearest lot line_________________ p ❑ Number of pits--- .material-----------------------Size:iDiameter-- ----.Depth---------------- r� 1: 1 Cesspool: Distance from nearest well_________________Distance from foundation_--_______�----'.Lining material__._____.__.-_-_____.__.__.________._. --------Depth-----------------------------' {---------------- -Liquid Capacity----------------------------gals. v� f _- ❑ Size: Qiamete�.'-•-�------- --'--------'- Privy: Distance from nearest well------------------------------------------------- from nearest building___`______----.___________--________-----. ❑ Distance to nearest lot line------------------------------------------------- ----------------- --- -----------------------------------------•---•------------- -- t s Vii, I JI TRZ d. Remodeling and/or repairing (describe)-------------------------------------------------• --------------------------------------_-•--•------------- -------------------------------------------------=---------------------------------------------------------- ------------•----------- --------------------....--. I _______ ____________________� __________....________--.---_____...______________-_-___-----_ __ _ ________________________________________________________________________________ __________________ II —--'-•'------•------------------=-------------------------------------- -------' - ------------------------------------------•-•----------F-----------------•---------- ! hereby certify that I have prepared this application and that the work_will be done infaccordance with San Joaquin County ordinances, State laws, and rules and gulations of the Sari Jcac{uin Local Heal+li.District. l -r c _-. t __(Owner and/or Contractor ------,;- -------------- s--------------- ------- ---�-- -------- (Signed) - 1 Title-------` ' By:- - ---------------------( P (Plot pl showing size of. , location of system in relation to wells, buildings, etc., can be laced on reverse side). l _ FOR DEPARTMENT-USE-ONLY, f APPLICATION ACCEPTED BY C...-`--- -----__ DATE----- _-_ _- -'I--'----------------------------- REVIEWED BY---------------- -------------------- •-------- .... DATE "- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ----------------- DATE---------------------- --------------------------------- Alterations and/or recommendations:____:_-"-.___.-------------- ---•----•--------•--------•--------------------------------•--•-------------------•--------------------......------ --------------- ------------------------------------------------------------------ -------- ------------------ ------------------------------------------------------------------------------------ -------------------------------------- ------------------------- ----------------------------------------------------------------------•-----------------•--------••-----------•-------•----------------------------••-•-------- -----------------------•------ � ---- FINAL INSPECTION BY:-'----'-L------- _ -- ----- ---------'-------- - t :��! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street -,, _ 124 S_ycamora Street, 205 West 9th Street Stockton,California Lodi,California l mem4w!Cal fornla l-1 Tracy,California [B-9 REVIBE�6-69 r.P.ro.24 6.60