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FOR OFFICE USE: - ------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- -- (Complete in Duplicate) -------- ----- This Permit Expires 1 Year From Date Issued Date Issued ----------- --------Z--4 ------- - ---- - Application is hereby made for 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. �4 e JOB ADDRESS AND LOCATION------- ......... --------------------------------- ----------------------- vaN---------s Owner's Name--------------- ----------CR-0/E -yi------------ ------------------------------------- Phone----------------------------------- Address.......................Pi...0.........T3.4?X_-----------Li 2-L----_-_----------&ZO.-ROP.........----------------------------------------------------------------- Contractor's Name-----OW IV --------------------------------------------------------------------------------------------------------------I Phone----------------------------------- Installation will serve: Residence Rl'-Apartment House E] Commercial E] Trailer Court E] Motel E] Other ❑ Number of living units: Number of bedrooms 2 Number of baths Lot sizea------!7--------------------- Water Supply: Public system ��Community system E] Private [-] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E-_`Gravel E] Sand Loam E]. Clay Loam 0 Clay 0 Adobe[] Hardpan E] Sand Previous Application Made: (If yes,date-._-____--_----) No New Construction: Yes E] No Kr-__F__HA/VA: Yes E] - No TYPE _OF ST6LLATIQIN_,ANQ-SE.EC—IF—lq.ATIO—NS-.-,---.-,-,, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-CW---Distance from folgdation--.10-------- aferial__Rf�.D_.W_LP_0_1b--- --------- d depth_ r I Capacity----- --- --- --- ---------- No. of compartments----- 2--- ----------.--Size- ---Liquid dep�h__ ..- --- ---------- Disposal `elcl: Distance from nearest well- Distance from foundation---/0----------Distance to nearest lot line________ __---- Number of lines_______-2---—----- ------------Length of each line-_46-0----7!k__y_6�'___.Widfh of trench..--_Z-1171 --------41--- 15 Type of filter maferial_:P)_0_C_K----Depth of filter material------ -----Total length-------------------- --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits.__-_----_-__._----Lining material-----------------------Size: Diameter--___-_.--.;-----_--Depth-___.:_------_-_------_------__ C Cesspool: epth----- --------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.--------- --------Lining material----------------_------.--__-__-__-. ❑ aterial------------------------------------- 171 Size: Diameter----- ------------------------------ Depth--------------------------------------------------Liquid Capacity-.-.---- -------gals. Privy: Distance from nearest well------------- ---------- ----------------Distance from nearest building---_, ------------------------------- ❑ Distance to nearest lot line-------------------------------- ------------------------------------------ ------------------------------------------------------------- Remodeling and/or repairing (clescribel:----N ---__13�_'D W-OP-D------T-II&K.......VA-K-l-, ------------------ __]� V� ------- ----- T_ -1-5------ C-1 T —-----I I hereby certify fha I have prepared this application and that.the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the S n- Joaquin Local Health District. .. ....�o -------------------------- --------- -------.(Owner and/or Contractor) (Signed)-------- ------- -------- ---- ------------- -- ----------- -- -- ------------------ -- -------------------I-- -------- - - -------- ---------------------------------------------------------------------- (Plot plan, sh6wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART NT USE ONLY DATE------ APPLICATION ACCEPTED BY-------1 T ---6tl, --------- REVIEWED BY---------------- -------- DATE-------- ----_-------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------- ------------- DATE- ---------------- ------- Alterations,and/or recommendations:_-- ------------------------1------------- --------------------------------------------------------------------- ---------------- ------------ ------FOA--------- _60,R. _V) (Z W ------------------------------------ ------ _-N----A---------------- ----------------------- ----------- ------------------------------------- --------------------------------------- -------------------------- ----- ------------------ -------------------I------------- -- ----;,;�------------------------- /I- b:-A7, -------0OWNT-k-------- ---------W_ -------- oe---------/W ----------------------- --------PTS---------51010WN_ -------IAISP,------W__A_5------- ---- --- N FG' - Date------- -------A_ ---------------------- --- -- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C13.