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FOR OFFICE USE_�-- --- --- - ---------- APPLICATION FOR SANITATION PERMIT Permit No. _;��1- •_ � -----_ -----.--------------------------------------- ------- (J_- --------------- :-- -- --. (Complete in Duplicate) � � / ---------------------------- - - Date Issued --- -- __ /41 -,-_f°- � ___.____=_ :_�.S_EM_.r7Z�" This Permit Expires 1 Year From Date Issued -- 2-0a l (L(©— 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 ma a in compliance with County Ordinance No. 549. A4ftNT-F—Cq . : ��6 LO - L- lJOB ADDRESS A DCATION ----- ----- Q -------------------- Owner's i NamePh-one.------------------------------- Address---- ----------- Address---- -23==---`-1.3X-------_73--7-A_-----•-•-----IWAIVT-v_E7C09------------------------------•----------- ----•---- -------- Contractor's Name------,r "*3: -A I��' -�. .+.. -R 0��t �~.+ �� Pho6e�� ------------------------- ----------- _ ----- -- .;-- Installation will serve: Residence EApartment House�[[r Commercial � Trailer Court ❑ : Motel ❑�70thte o Number of living units: �___ Number of bedrooms ___f__ _ l-__:_ 4 " µ _ Number of baths - Lot siz ;�AG ---- ---------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to WatFTable -_ ft. Character of soil to a-depth of 3 feet: Sand iGravel ❑ Sandy Loam ❑ Clay Loam ❑: 01ay,0� Adobe ❑ Hardpan E] Previous ard anE]Previous Application Made: [If yes,date____________________1 No Va` New Construction: Yes Not❑ FHA/VA:, Yes E] TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitted-if=public-sewerp-is available within 200 feet.)- Septic Tank: Distance from nearest well------------- Distance from foundation---------------------Material__________....________.___-_____-------___---_. EX6T!/YC— No. of compartments------------ ------------Size----------------------------.-•-Liquid depth----8------- - Capacity----------------------- Disposal ---------------------Disposal Field: Distance from nearest well___ ____Distance from foundation______ ___ _________Distance to nearest lot line________.___... }��T!/s[, Number of lines------------- -----� -------Length of each line-_------� ---.`--_i. - Width^of trench--------�Z_ ._____r___________-.� �}- Iq DD Type of filter material-,___ G __Depth of filter material-------1_ _ Total. 1'en th_______________ __Q_______-______._( Seepage Pit: Distance to nearest well----------------------Distance from foundation------------- to'nearesf lot line_____.____.____- 1 X❑'�. Number of p;fs----------------------Lining material--------.--------------Size: Diamefer__.------------------Depfh-------------_------------------- Cesspool: Distance from nearest well-----------------Distance from foundatiori___._._.____ ___-.Lining maternal_____________________________ ._. 1 ❑ Size: Diameter-------------------------- ----------Depth------------------------------ ------ Liquid Capacity------------------------_-gals. Privy: Distance from nearest well----------------------_____-______.___-_______-_Distance from nearest.building____.,_,-----------------------------___._. ❑- "Distance to nearest lot line--------- -------------------------------------------------------------------------- -------------------------------------•------------- . . - Remodeling and/or repairirig,{describe)--- ----------- -•--- -----•-------------------------- `--=�=--------------------------------- ------------------------------------------------------------------------------------------ --------------------- -------------------------.----� ,-- -----------------------------------------••-----------------------•-• --•--------------------- - - - I hereby certify that I have prepared`this application and that the work will be done din accordance with San Joaquin County t� ordinances, State laws, and rules and regulations v.o-the San Joaquin Local Health District. ;1 (Signed) _ -_---.--=-----=_--"� - --------------------------------------------------- I Owner and/or Contractor] rh = _ - - -- --------------- --- - ----- . . ...... .... [Title]_ T==--- (Plot plan, show.ing.size o1 f�lot,.location.` of system.in relation�t •wells, buildings, etc., can be placed on neve se side). Z. Im#,A93Z # FOR DEPARTMENT` USE-:Ot+1LY APPLICATION ACCEPTED BY t' ----- -- - -DATE _�� _�1 "` �'_ REVIEWEDBY----------------------------------- - ----------------------------------------------- `..'�� DATE . , , � .� . Alterations PERMIT ISSUED--•------------_1---•----------- :---------------------------------------------------------------- D.,ATE--------�, �''^�'4� -N%,/BUILDING BUILDING `— �, —.— — * and/or recommendations' ...�. .. .� - '---- -----•------------------------------------•---•---- ------ --.-----.-.._..r, t-------------- ---------------------------- - ---- --------------------------------------------------------------------------- ---•--- ----------------------------------- -----------�-------------- -- • -- - --- ------- --•--- •- ------- ---- --�'-•�-k------------N- -----fi--O-,--+L--_- '_+-_m�!A--- -------------------------------------------- ---- - ------�---��---��- ----------------------------- N_a sv FINAL INSPECTI ----- - - --------- Date----------------- 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 E5 9 REVISER B-69 3M3-•63 r.P.CQ.