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\FOR OFFICE USE: x. ----------------------------------- APPLICATION J3 � ----------------------- - -- FOR SANITATION PERMIT Permit o. ............. ..... __!- - _ `'_�..___-_ (Complete in Duplicate) ------ -'- `- -- , .. : . Date Issued �, _._-- -`--------- :---_.-_. This Permit Expires 1 Year From Date Issued 11 Application is hereby made to the San Joaquin Local Health District fora ermit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 54 _ JOB ADDRESS AND LOC k / v ------ --- ----- ---••-. -= �� A ' �. . Owners Name---------------- ��1...' � � _ ��-�Q�� ' ' --------- hone19`��`� -A M1 ' Address.....................-------------�------ -- •- - ---------- ---- •--------- -t ---------------------------• r v t F r - } Contractor's Name_---------------- ---- -- -- - _------------;�.Z/= � ••--•-------- ----------------- hon�.�__. � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer court'❑ ,, Motel ❑. Other ❑ - f Number of living units: _1_--- Number of bedrooms _-' Number of baths ;Lot size -K 7-!- �...r------------------- .t 1 1 Water Supply: Public system'El Community system'E] Private F], Depth to Water Table.. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cay ❑ Adobe Hardpan ❑ Previous Application Made: IIf yes,date---- No New Construction:+Yes ❑.� No FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available within.200,feet),_ [ ` ❑ KtSr / - pr/aeiaiSeptic Tank: Distance from nearest well_--" ✓---- D ance from foundation-------------- Ca acit -------------- No. of compartments----------------- - -_ B ---- - Liquid P-h Disposal Fie€d: Distance from nearest well--fYDA)6-_Distance.from`f6undation./42-r-.--=.-.-.Distance to nearest lot line_ ------------ Number of lines----�1� Cly-.----.---Length of each line---,Z�._� t{_ - Width of trench-�4__«.-__.---.1--:-_-. Type of filter materia,__Q, -- :Depth of filter fn�aterial_-_-`- --- .--.Total length-.-----_ ....� __-_--__-- i Seepage Pit: Distance to nearest well.---- 6- __Distance from foundation_-f r1__.'.__'Distance,to,nearest lot line_ --� t E Number of pits.- it !---Lining material-_-_._:4._ -. ._-_._.__.Size: Diameter_-�?� -_�r_--- Depth-- ------- --------------------- Cesspool: Distance from nearest well_-_-----_---:._Distance from foundation-------------__----.Lining material--------------------------- ----------- El Size: Diameter------------- =-------------------�-Depth-....--------------•--------------------------; ;Liquid Capaeity gals. Privy:j Distance from nearest well------------------------------------------------ Distance from nearest, - building--------------------------------- Distance to nearest lot line------------------C:+-- n - +w - + „x Remodeling and/or repairing (describe): = '=- -••-= `------------------------•- -------------------------- ----------------------------------- -•-----------------•--•----•---------------•----•-------------------•--------------- - - -•-- ----- ---•---- ,.. N� 4 ,_..t. s. - .1 -----------------------------------------------------------------------------------------------------v E I hereby 6ertify tha+'I ha r ared fhis�application and fhat the work will be done in accordance with San Joaquin County ordinances, State laws.'an ules md regulation f th Joaquin Local Health District. (Signed)-------- -------------r '� ----------- _ ------- --- -- ------------------------------ - -(Owner and/or Contractor) by:-------•-•--------- - N`=` t (Tit ea h ��'��i (Plot plan, showing size of lot, ocation of system in relation to ells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTEDBY ------------------ DATE---------- - ��' r----------------- REVIEWEDBY---------------------------� ;-- ---- -------------------------------------------------=------------------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED----✓---------------------------------------------------------- ---- ----------.-... DAT or recommendations:__ / - - E..---------- ------------ r Alterations and -_ t �T_--. -- - -__ ---- ------- -- ��C- '� 1E ------------------------------- 1-------------------------...---...-.----------------------------------- -------------------- --t--- - o --- -----------------------------------------_---------------------------.-------------------------- -------•--- -------------- F FINAL INSPECTION BY:-_ - ---- - �-- -- - -..4,----- Date-- ----------------- # i SAN JOAQUIN LOCAL HEALTH DISTRICT h 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ED-9 REVIBED B•89 F.PXQ,210 6.60 l4 / P