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--_----- APPLICATION FOR SANITATION PERMIT Permit No. p_ ----------------------- - - ---- (Complete in'"Duplicate) 9� . Date Issued --- ---..----------._____ ---_---_ ___ 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. JOB ADDRESS AND LOCATION Owner's Name---- -------------- 11 1 � ------------- Address 'J_�----•-----_= - ` I �}- ------------•-------------- ------------- ------------------------------------------------------------ •---------------- Contractors Name-_-_L__-_��._ _ __ ___ - ', Phone__7�1 'y�v � Installation will serve: Residence"o Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j Number of bedrooms _ __ Number of baths J.... Lot size ---*W-4nS--------------------_--------------- __ Water Supply: Public,system ❑ 'iCommunity system ❑ Private )@ Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand �9 Gravel ❑ Sandy Loam ❑ Clay Loam [} Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-.-- ---------- ......} No New Construction: Yes ❑ No$ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is av'a'ilable within 240 feet.) bafoundation �- Mate'P.rj� al- ONO— _I _ '�___________Sep Tank: Distance 'nearest - h — B � Nocoin artmets__W �i:� .__....__ ze7 � 4ALiquid dept 'Capacity- fCZ------- F Disposal Field:`, Distance from nearest well__- ----------Distance from foundation_._._`:-XGA--------Distance to nearest lot line____-_._.__. ❑ Type filternmaterial- `-� 1 __De thhofffilteh�ine . .Width of trench___________---------------------- Number �} yP :f - r p aterial �, Total length U '� t Seepage Pit: Distance to nearest well-------------------._-Distance from_foundation--------------------Distance to nearest lot line_------------ ._ . 7 ❑ Number of pits------.----------------Lining material---------------- -----Size: Diameter--.------------------ Depth---------.---------------.------- j Cesspool: Distance from.nearest well------------------Distance from foundation-------------------.Lining .., material______.--- -_---.-..--..--..--_- ---- ❑ ze: Diamete ' ..De th--- - -- - -----------------------------------------Liquid Capacity gals. Dsnce romnearest well_________________ ______________________________Distance from nearest building__._.________._ -------------------------- Privy: a ❑ Distance to nearest lot line-------------------------------------------- -------------------------- -------- ------------------------------------------------------------- 1 Rem/odelin and/or repairing (describe):_. Z?2C ,-r;'fl�f�/� ----------------- /------l�l� �r/f�------• ` lig e ---------•----------------------------------- ------ -----" -------------------- ----- --------------------------------------------------•-------------------------------------------------------.-------------------------------------------------------------------------------------------- I hereby certify that 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 San Joaquin Local Health District. (Signed)--_ �a r � G_ ------ -------------------------------------------------------- --------(Owner and/or Contractor) w sY:------------------------------------------- -------------------------------------------------•------------•- -----(Title)-- ----- ---- -- (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY----------- - __ DATE-------` .6.''.[ ------------------------------ REVIEWEDBY----------------------------------- --=-------------------------------------------------------------••----- DATE---------------------------------------------------------._. '. BUILDINGPERMIT ISSUED-------------------------------- ------t-------------------------------------------------------------- DATE--------------------------------------------------:-------- Alterationsand/or recommendations: -- -------- ----- ----- "------ -"--------------------------------------------•--•-------------------------------------------------------- ------------------------------------- ----------------- -------------- ----- ------ ------------------- •------------------- ---------------- --------- - ----- --------------- - - `• d w FINAL INSPECTION B :. ! ! Date1 '(? �6 '--....- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 o.