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FOR OFFICE USES° ' . y ` -------- ---- _ APPLICATION FOR SANITATION PERM17� Permit No. -------- T (Complete in Duplicate} T Date Issued.� -� - �� --------------------- - ---------------------------------------- - .-_-.-__ This Permit Expires 1 Year From Date Issue ; 19�-aro-4 2- d. Application is hereby made to the San Joaquin Local Health District for a perm i to c uc d instal e�w herein �le,�er,HFtoF- This ap.plicaticirils.made:in compliance with County Ordinance No. 549. r z [-N Al 11 JOB ADDRESS A-N CA ION. - �- ktzt& } '-- �f _ > - Phone,. -- -// .flf/.f" ' - _,---- •-- _ --j------• nn__ M Y Owner's Name.- t t! Address-.---------- - ------- Ph �y -------- ---E one 6 . Contractor's Na Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel [I Other [INumber of Irving units: __.�__ Number of bedroomsg _'_�Number.of baths _.--_2Lot sae __ ..!_f I----- Water Supply: Public system ❑ .Community syst m rivate ❑ Depth to Water Table .___S._ ft• Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ElClay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------ ------- No New Construction: Yes No ❑ FHA/VA: Yes Er-'O"No _. r_, - �. .-��.t..._. _...... _ -,� .:. .�-•ter.-A-d. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ubli sewer is available within 200 fee/tet}.] i Septic Tank: Distance from nearest w {I_ Dis}ane from found n- rf Ma i f 5 - --- -- ,---- rr��i uid de th-------- Capacity No. of compartments--- _ - Siz --j----- -- G P. Pw pis osal Field: Distance from nearest well-> �.t--___Distance from foundation__.-----,Distance to nearest lot line_______ V Width of trench. 6 -..... Number of lines-__._ - Length of each line-e I t Type of filter materia Depth of filter material-- - Total length ,.. �d ,.T_ .-- -- ,p Seepage Pit: Distance to nearest well....... ..... .�-- -Distance from foundation-------------------.Distance to nearest lot line---- _.._- _... f Size: Diameter-- ------------- --- Depth--------------------- ---------- El Number of pits-------------- Lmmg_(naterlal--------------------- . -- . Cesspool: Distance from neaies+ well _.__Y4 Distance from foundation------------------- Lining material------------------------ Size: Diameter------- V Depth-------------- ----------- -- --------------------Liquid Capacity--------------------------- gals. Privy: Distance from nearest�well------------- ----- --- -----------=----------- Distance from nearestbuilding------------------------------------------ ---------------- ❑ Distance to nearestlof'line- ----------------------- ------------------------------------------------------ -- a l... . v . ....«..• - - r ----------------•------•---- i ----•----- ---------------------•-------- Remode4ing and/or repairing (desc ---- i - -------------------------------- -- -- r---------------------- ----- ------- cc ,. C --- - - - -- _---- . _---------___ -------- _____________-______ __-_.__._______-____________._--____________-_________._______.___ry.--___..________-_-__________.________.....-._____.----------- I I here- by- -certify th_a_ __ t4lhave prepar. ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aGwrules and regulations of the San Joaquin Local Health District. _ --� _ .(Owner and/or Contractor) Si ned {{ - ;,.r .,. — va( g I------5>✓F�"f.iG__"T•Xfi1ti1�" �R�l1C� - ' .. �- - 2915 E Miner Ave.,' HO.fi-3841 ] --- --- - -- (Ti#le} By:----------------------------------------- ----------- g P ---- -.--- ----- (Plot plan, showing size of lot, location of system in relation to w IIs, buildin s, c., can laced on reverse side). FOR DEPARTMENT USE ONLY - .� --�----- APPLICATION ACCEPTED By----------- _0------------------------- ----- ----------- - --- ----- DATE-------.,�P_`.�r,�..._" ,5 REVIEWED BY-------- i ------------ --------- --------------------------- ---------- DATE----------------------------------------------------------- - -------------�--------- -------- --------- - BUILDINGPERMIT ISSUED-----------------I-- -------------------------------------------------------------------------------- DATE--------- -------------------- ------------------------------ / 9_j Alterations and/or recorr�menda:Mans:_'_-_----------------------------------------------------------------------------------------------- ----------------------- - --- -------- - Mme. --------------------------- ------------------------------------------------------- •----- -- ------------- - � -------- ---------- ------------- ------------------------ Ie,1249,77--- Date ~� ~'FINAL INSPECTIO � ---------- -- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Lodi,California Manteca,California Tracy,California Stockton,California F.R.0 O.