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FOR OFFICE USE: �.. - � - Permit-No. ------------------- ------------------------------------ - APPLICATION FOR SANITATION PERM - -------- ------------ ------------- -•. ......................- --------- (Complete-in Duplicate) Date Issued 44A _- ._. __--__--- This Permit Expires 1 year From Date Issued Application is hereby made to the San Joaquin Local Health District The a permit to construct and install the work herein described. Zo -- ©rz0 � Z�• This a plication is made in compliant with County Ordinance No. 549, -r fv� r , 1 � JOB ADDRESS AND LO/CATIOt71'_�_�.��------ - - -K�__=:.-._ _�----------��--- -----A-t �t�------��, L- 0LA)�L-_�,. ------ Phone Owner's Name--••----- ----------- � ---- QTR~------"_.:.-__'_ = ---- ------ ----- -- ----- - �_ ---AL--•----� - -------------------------------------- Address.------•----------- Q��}.�-------- ----------�•T�-��-'------- -----------••------------------- -----•- -- ------------•---- Phone---•-- ---------------•----------•- k) Contractor's Name aW.--------_.__.......--- ----------------------------------- •-- _°,_ ---- - --- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ __-- Number of bedrooms 3 Nbf baths_" Number of _2-_ Lot size __-_-�.� --- X----�' -------------------- Number of living units: Am �` -� Water Supply: Public system ❑ Community system 0 Private [[Depth to Water Table3�- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam tj �Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ` Previous Application Made: (If yes,date----------- I . NoE5_'New Construction: Yes Erj�o ❑ FHA/VA: Yes �10 TYPE OF.INSTALLATION AND....SPECIFICATIONS ;. ��:.,;�,,.,;G, �-_-mss_. �-•� --�--��- - t- -- (No septic tank or cesspool permitted_if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well"_-5-0___Distance from foundation_10--------- __CQ .{r� i No. of compartments------�_-.t_---------5ize�_){_I_�=..�:�i.--Liquid depth-----�---�..-.--.Capacity .--�---- Disposal Field: Distance from nearest weld-_Q0-__-_Distance from foundation-__- -------"Distance to nearest lot line_i_, Number of lines.__a."":-- ....----------------Length of each line,_..__50--- ---------- Width of trench---------2V--'-------------- rr i Type of filter ma --- of filter material____-_ ______To#al length__-.___.__�oO----- ""-------------- # ----------Distance to nearest lot line_-�_-5 Seepage Pit: Distance to nearest well-_../ _�.-.___Distance from Touni�ation___�Qf�� p fes_ t Number of pits... _.r�—__-___----Lining material---f3DO.GK. Size: Diameter__ ___ __ __ __'_-Depth----/.2 iCesspool: Distance.from nearest well ________________Distance from foundation----------------- -.Lining material----___-.--_---.-_-____"-____-_--_-. i ❑ Size: Diameter- -- --------- ----- ----------- ----Depth--------------- ___ ------ --------- -------Liquid Capacity-------------- -------------gals._ Privy: Distance from nearest well------------------------------------ " ":=••=-•.Distance from nearest building------------------------------ -- - ❑ Distance to nearest lot line------------------------ ----- -- --------------- -- i •------------- Remodeling and/or repairing (describe)---------- ------- ------__._•.•--.----------- --------- - ------------ - ----------•------••---------------------- --------------------"--------------------- -----------------"---------------• ---------------------------------------- :------- --- ----- --------------------------------------------------•---------------------------•----------------------------.....=•__------------------------------ ------------------------------_-------- 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. _ - _(Own-sr-�-a-n- or--on- r - - ---Si nerd -------"------------ - (Plot plan, showing Size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED,:.SY---------T`F.-O-------- - -------------- -------------- DATE REVIEWEDBY---- --------------------------------------------- ----------------- ------ DATE-------------- BUILDING PERMIT ISSUED__1;--__`- -------------- - -------------- .-•-- ------ _ D TE--`---------- -- pp �.. Alterations and/or recommendations:._ - _ " ` ----•---------- ---- --- A -6v �i�- /N�ST74 L 9 r45.--;---- ---------- _------------------------------------ . --- --- ------ - - --------- - ----------- --------- ------------------- - -------- --- ------- ------ ------------- Date_............. - -7,/ FINAL INSPECT -- -- - - �----.- ----- --"- - - i-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California + Lodi, California Manteca,California Tracy,California E.H.94M 1-67 Vanguard Press