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FOR OFFICE USE: ----------------------------------------- ------ ------- C2.1��1 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) 1 Data Issued ------ -------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const uct and install the work herein described. This application is made in compliance Vith County;Ordinance No. 549. JOS ADDRESS-AND LOCATION_. L 'E r - Owner's Name---- 1 -~{_ - .__ 8. E" 'T'- -E�.y ----------------- ... Phone.__4�_.3:n -- Address07[ -1-1 --A s -- � � a -eKNP . -$ - _ ._ or, '�N � C - Pho ne-_4 --ContraCommercial installationwillserve:'Residence "ApaFtmenTrailer Court ❑ Motel ❑ Other ❑ ,�I umber,aJI g ;n_ �_,tNumber bf bediooms ---�Nymber of baths . �-- Lot sizeE ' X -- ---------------- Ivm unit`s Water Supply Qubli�C syst m OsComm iy system 1 # Private Depth t Water Table __ ft. r• Character of soil to a depth of 3 feet: Sand ❑ ave![M Sandy Loam ❑ Clay oam' ❑ 'Cl"y❑, Adobe [] ,,.Hardpan ❑ Previous Application Made: (if yes date )INN New Consfrucllll#ion: Ye . ❑ :No ❑ FHA/VA,•Yds ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: p is available within 200 feet#) Voor i : (No p p P p ante from foundation___-- Se tic Taokse tic tank esfrom nearest well- �_e Dis �� 1_&__--__.Material_-�'r'ee�.Sf_C------------- No. � + • ---- No, of compartments.-.-.--. .- Size-- -Liquid depth_-.-....-_..�+,___------Capacity-t - - �1., � f Disposal Field: Distance from nearest well_.....-.Dis ancevfrom foundation_._._W_-#.----.Distance tonearest lot line-109! C3 Number of lin -------- --.__--...___± Leng'tli f each line____.____-5.6\.___.Width--of trench._-_-__ 4��!------------- N , Type of filter material---, Depth of,filter material--------€.5.-- ..Total length_-N---L-CP-Q-------------------- Seepage Pit: Distanke to nearest well_____ ________ ____Distance from foundation----._---:------ p �ic ,istae.°to nearest lot line----------------- 1 ❑ NX er of pits.---"-------------�-Liming material-----------------------Size: Diameter----.- ---- -----DeptH----.---4----------------------- Cesspool: --------------------Cesspool: Dista ce from nearest well ___w__--Distance from foundation._._-._____...____:!fining hInaterial- ---------------------------------- ' ---De th--------- ----- --------------- - --------------/Li uid-C/ acit ❑ Size:.Dlameter-- -- p- 1 .� q P Y- =-------------------------gals. a - - -- to Privy: Distance from nearest well--- Distance fromnearest building ------------------------- ❑ Distance to nearest lot �ire--------------------------------------------------------------------- ---------------------- - ----------- Y 4 jt Remodeling JF and• or re airin describe :-----_._ j- M__ __--I ------------------ ------------ -- - -------- - - ---------------------------- ' ------ ------ ------------------------_------ --------------------- - --------------------------4 ------1-_.:--- ---- _-•_•_-----;_4 -------------------------------------" _ -•------------- _. - - __ r--------------------------- I hereby certify tha 'l have prepared this. application and that the work wi01. be done in accordance with jSan Joquin County ordinances, State.laws, and .rules-and-regulations of the San Joaquin Local Health District. (Signed) .•- - - -�-� � -- �-- -- t- J ---------------- -----------(Owner and/or Contractor( a z B . . . ---------------------------------------------(Title)..--�. ..--A- j' --------- (Plot plan, showing ize of,.lot, I cation+of system in relation to wells, buildings, etc.,v-an be placedT reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B [ ------------------------------ - ----------------------------- DATE------- /,— ------ ------- - ---------------- REVIEWEDBY---- ----- --------- ------ --------..------- ---------------------- ----------------------------------------------YX TE---------------- BUILDINGPERMIT ISSUED-------- -------------------------------------------------------------------------------------------- ®e-TE------------------------- -------------------------------- Alterations and/or recommendations "k ^ ------=-------------- r' } ---------�� _ t - ------------------------------------------------------------ _ ------------ ----- ----- •------ ----------------------- -._. -- ------------------------------------------------------------------------ - ------------------ - -------------------------------------------- E FINAL INSPECTION BY------ ` t `- --------------------------------------- Date---- �1�� ~ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. f, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO. I