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FOR OFFICE USE: ff p ----""--"-""-"-""------------------------"------------- - APPLICATION FOR SANITATION PERMIT Permit No. ___ or --1-••5 ---��w� - ------------- (Complete in Duplicate) D8}e Issued --- ------------- -- -------------- This Permit--Eziiiies`"1"Year From Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549. ------------- 3 .5----- �E----• -•"-----•------------ •-------•-`-------•---•.----- JOB ADDRESS AND LOCATION._.. t 1 -- Owner's --_V ]1 vII—S ------------------- ' I ------•---•-----•----•--------- Address------'417_{x------- -----•----"•--------------------- *��'' -----------••------------------------------------- �Phone Contractor's Name---- Installation will serve: Residence g Apartment House [ICommercial E] Trailer,.Courf ❑ Motel ❑ Other ❑ Number of living units: .__ --- Number of bedrooms ��Number of baths Lot size __ Ott_'__"X: .•4-Q�-----• system' Community system ® Private ❑ Depth to Water Table •�hL Water Supply: Public ❑ Y -_ .- ❑ Y ❑ Y Adobe Hardpa ` Character of soil to a depth of 3 feet: ':Sand❑ Gravel ❑ Sandy Loam Cla Loam Clay 1 FHA/VA: Yes ❑ No �{ Previous Application Made: elf yes,dote""-. 1 No a New Construction: Yes +�. 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-`Wt_y1�_Distance from fbundati n- dap} - Mat�eria�L_-_C.C�Y1-�-'�.f -�••--b- -�• � p Y - I'foun t . No. of compartments {� 3 Size_ = �_ -.,-,Liquid~< Capacity., from nearest well �y�-rte"-Distance frotion_._J0.._""""--..Distance to nbgrest lot line----_�........ Disposal Field: Distance a tt Number of lines..-"__2"""----------------------Len th of each line_ _: l bWidth of trench--"-"-- _____-"""""-"".""-" ® Depth of filter ma#e If al- TLS ±�. "--Total lengtlf-_=--- --Via.'---------------•----- Type of filter material.."r_0"� p Seepage Pit: r Distance to nearest well-------- -----------Distance from foundation------7.__-----_..Distance to nearest lot line-------- ------ p Linin material----------------------.Size: Diameter `-t.. --- = Depth--------------------------------- `Al ❑ Number of Its_---- 9 Cesspool: Distance from nearest well-----------------Distance from foundation--- --"---.--.Lining material--------.--------------------- -Is CA l Liquid Capacity ••---------------gals. ❑ Size: Diameter"u ` ----------Depth--•-----------------------------------{--- k q p tY '•�---- ----------._Distance from nearest building_________.___---.--_------------------ I Privy: Distance from nearest well-"-----_------------------- ----- - . I ❑ Distance to nearest lot line ............................................ ------------------------------ ---- ;.F e— .r_.. Remodeling and/or repairing (describe):------WA40----- f� ;# .!!i .::_ _ _"":.-------- f-•-----------------"----------- G ---------•-------------"---------------------------------- ----------------•------------`------------------------•------- --------•------- - --"-----••----•----------------------------- ' ---------------------=---------------------------------- --•----------------•-------------•------------------ !�• f I hereby certify that I have prepare this applica+ion and that +he work will_.be_done in accordance with San Joaquin County f ordinances, State laws, and rules and a ulations of the San Joaquin Local Health Dis#tett. ----------------------- ""--(Owner and/or antractar) ' ---- (Signed)_ ..By: -- - - ------ ••-----• ---- -- - -- (Title).- ... pia , sowing size of to , oration of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPAARTMENT USE ONLY APPLICATION ACCEPTED - --- ----"-"----" •---------------- DATE_. _A1..-fsz`"- -------------------------------- REVIEWEDBY--------------------------------------------:-- ------------------------------------------------------------------------------- EWE-------------------------------------------------------------- BUILDINGPERMIT ISSUED------•------ •--------------- ------------------------------------------------ DATE Alterations and/or redo mmendations:----(1.,ctivC- - -S- - � CIV-Z' - ---- - -------------------------------Ir--- -----•----------•---------- - ----- ------------ -------- dr FINAL INSPECTION BY: -..-�--� -- - - SAN JOAQUIN LOCAL HEALTH-DISTRICT l ;� _.a i F- 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i E6.9 REVI6f0 8.89 F•P•CO,2M 6.60