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vn v, 1 1%.,L VJC: _ - ---------------------/'-�{.5 APPLICATION FOR SANITATION PERMIT Permit No. _ _ °.• -3 --- ------ - (Complete in Duplicate) ----------- `-1 This Permit Expires 1 Year From Date Issued Date 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. JOB ADDRESS AND LOCATION___ -- r.y _ 11- ,, " `` 1 !t o_-------- Owner's Name 2 - 'lV2!e �. ' . /5---- ---------------------- - Phone Address 0_ t �- vv ---- -%`--- - - ------------------------------------------------------------------------------------------- Contractor's Name__ -= riY�S-------_- __..til.�' •-------- Phone-- Installation will serve: Residence M, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Ndilh6r of bedrooms Number of baths , --- Lot size ---- ---, , . --------- ----------- Water SuPPIY Public systemCommunity system ❑ Private ❑ Depth to Water Table ---(,('-a eft. Character of soil to a depth of 3 feet: hand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamk Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If _- - -_ - _ yes,date___-- - ) j No [ji�New Construction: Yes ❑ No FHA/VA: Yes El No ❑�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoo� ermi+ted if public sewer is available within 200 feet.) Septic Tank: Distance from Barest well-__t_'--`..__Distance from foundation---e f49 _ - ----------.Material---O2�Ei../S��'T------------ --------,. No. of compartments----.A-- ----------Size__(X- - ---�---_Liquid depth----�-�--��----Capacity--/f" --j�?----- � � Disposal old: Distance from'nearest well_ _.____ _Distance from foundation____/4_. --Distance to nearest lot line_-_�-'-__- Number of Iles----------/----- -_. ---_---Length of each line___ fZ_' I'll_.-__.Width of trench_-___ -"-----___-__- Type of filter material__ _ Depth of filter material __�-- -Total length------ p--__ Seepa it: Distance to nearest well __________---_Distance fr foundation___./p--.___.Distance to nearest lot line___'_._ Number of pits___ __-__Lining material_• �� Size: Diameter_____ Dept- -- -------- p �� Cesspool: Distance from nearest well-----------------Distance from foundation--- -------.--------Lining material____ � ❑ Size: Diarnfler__. . _-_____ --- - --- --- Depth----- - -------- - ----- ------•-Liquid Capacity----------------------------------- Privy: --- als. ------------9 Distance from nearest well _-__________ -------------__.___________�_pistance from nearest buildin ❑ Distance f&-marest lot line - Q 9 - ....... 1 I --------------------------- ------------------------------------------------------------ ---------- Remodeling and/or repairing (describe):------- eD - describe):_____ - -----------------------•----------------------------------- ----------------------------------------- ------------------------- •---- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have,prepared this application and t e work will be done in accordance with San Joaquin County ordinances, S+a+ ...lrawYrGt and regulations of the aquin Local Health District. �,. (Signed) �. -- -- O r a /or Contractor) B - Y�--------------- ------- �- -- � _- - ----- ---(Title)---- --�- (Plot plan, showing size of lot, )Nati of system to relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY APPLICATION ACCErTED BY_.__-_-.___ . f --------------------------------------------- DATE------0/- REVIEWED BY----- ------- -------------------------- ----------------------- ---------------------------------- BUILDING PERMIT IS$UED------------------ - A E-- •--.---------------------------------------------------- and/o recommendations:----- - DigTE--------------------------------- ------------------- Alterations ------------ P ,' — 1�_ — -v---------- -- -_----- / u y - 6ct l!'e r ---- --------------- ----------------------------- ------------------ ---------------------------------•------------- A-------------------- ---------- -------------- - --------- --- ------ --- FINAL INSPECTION BY:----- '� Date _ ------P' _------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoz*lfon Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street F.a.co. Manteca,California Tracy,California