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� FOR OFFICE USE: f __________________________________________________________ .h __ ----------- ----------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. ./2.7,2 9. :. " ---- ------------- -- (Complete in Duplicate) s n Date Issued F. -------------- ----- --- --------�-------�--------"- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No..549.. i•. J08 ADDRESS AND LOCATION _-_•_ ;. ___._.__- _" -8-1 Owner's Name------------ -------L/_ Q�! -- ------- -------- Phone-----------------------------.------ Address- -----------------••--•------- 00 . j------------- •• ---•---- _ ---.----------------- Contractor's Name----------------------•--- .-F-` 0- J-6 �-- -------- Phone--- fntallation will serve: Residence.; ..Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑; Number of living units: ___- Number of bedrooms _,2-Number of baths ___L_ Lot size _____ jam a�___-X.__t7_�. � ------------- Water Supply:. Public system Community system ❑ Private ❑ Depth to Water Tableft: 1 Character of soil to a de th.of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p .. ❑ ❑ Y ❑ Y ❑ Y ❑ �.�_, � p ❑ Previous Application Made: (If yes,date____________________] Nom New Construction: Yes ❑ Nci;K� FHA/VA: Yes ❑ No'M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.), �eplic ank: Distance from nearest well....��O___ Distance f om foundation______ __/___Mate- - tial-- - - ( No. of compartments, •--------Size-- 1 'Y `'� =?� ,Liquid depth ---------�--f-- ---------Capacity--•---�067_ N6?r, i • isposal Field: Distance from nearest well..A�A,J,' ]istahce"from foundation-------10"._.Distance to nearest lot line_____ ________ i Number of lines______________________./__,------Length of each line___________L_OW ------Width of french------- � Type of filter material r_IC...:Depth of filter material_______/$----_------Total length----_______-� Sp pilge Pit: Distance to nearest well______g _.______Distance from f clafion_____ ._-.Dis}ance�to nearest lot line__.-14:=-.. r Number of its___..__ _ __ Size: Diameter____. __ _ P Lining material. Depth --------------- Cess ---------Cess ol: Distance from nearest well_________________Distance from foundation-------------------.Lining~ ' material_____._-� --"-_--- •__----❑ Size: Diameter ------Depth--------------- ------ -- ----------Li Liquid Capacity------••1----------- _-,---_, -------gals. A.. Privy: Distance from nearest well ____________________________-.-___________'_Distance from nearest buildin --------------------------------------------------------- ----- ❑ Distance to nearest lot line---------- .. #.. Remodeling and/or repairing (describe):_____..:_.Ali _ - --- -- - Plrc- 1 s'. r I hereby certify that I have prepared this application and that the work will'be done in accordance with Sari"Joaquin'County ordinances, State laws, and rules and regulations of the San Joaquin Loc f al Health District. 3 4 (Signed)-X-- $ ------------------------------------- --------------------------[Owner and/or Contractor g By: --------------------------------- ------------------------------- Title ------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR PAT ENT USE ONLY ; APPLICATION ACCEPTED BY---- - ------•---- DATE--------- 11 ----------- (a - -- -- - ------------------------------- - REVIEWED BY -•--`-----•------•---------- DATE --------- --------- ----=---------- - BUILDING PERMIT ISSUED--------------------------------- DATE-----•----------- ---------- Alterations and/or recommendations:__144Ww.-x i... -- -- -- ----- --- -- - -----.--._-_--- ------------------- ---------------------------------------------•----------•--------------------`--•----••--------••--------------------•------• 5 ---•------•-------- -- L-7, i �--- •--------------------- ---------•- -FINAL INSPECTION BY: ---------------------------------------------------•------- Date--- S _ 4 e,S �3 (,,2 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California � • , � ! Manteca;California TraCSr,California E8-9 REWBED 8.59 F.P,CO.aM 6-So b f