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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` Permit No. rz s.- --------------------------------------------------------- --------------=--------------------------------- -- (Complete in Duplicate) Date Issued __.-------------------------------------.------I--------- This Permit Expires 1 Year From Date Issued 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 made in compliance with County Ordinance No. 549. `( �1 per-.. 41-R - 1 -------- '©0. v __W0.00WAt31�,... JOB ADDRESS AND L ATION....�.�._p____ �¢RT'.�___1f1F'1'}� Owner's Name--- �_.---•--�f ' MC`�-'- -----•------------------"------------------------------------------ ------- Phone------------------------------------ Address ---�-�-------0-Q K-----..3Y3_-._..---..( / --A-------------------------------------------------------------------------------- Contractor's Name---------------------------------&W.N.F—_X_-'-----_-------- -------------------------------------------------------------------------- Phone.................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other r Number of living units: -1----- Number of bedrooms .2--Number of baths -1----- Lot size ... �?,�7 ......17 Water Supply: Public system ❑ Community s em ❑ Private W-15epth to Water Table .9--' ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ 'Hardpan ❑ Previous Application Made: (If yes,date_______-_-_`:_.----) No New Construction: Yes No ❑ FHA/VA: YesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �f- p t3 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 17 Septic nk: Distance from nearest well--,5- _--Distance from found—ation---- _0-------Maferi I_ CO N_�� �� qp �.��. C _ '•.... No. of compartments----- � _.__ .__Size--- X _. pacity./©d_O . Disposal Id: Distance from nearest w II 50--Distance from foundation �� ` Distance to nearest lot line__- �� ------------- Number of lines___________ ____ _ _ _._._Llength of each lme______,, -' Width of trench. ._.3�_____ Type of filter materia h.QC '�, Dep h �f filter material_.l?. __._ .Total length---------��___--------------- Seepage Pit: Distance to nearest well----------------------Distance from four'dation....................Distance to nearest lot line----------------- ❑ Number of pits-_-______.___..____Lining material_'__-___-___._-_._..Size: Diameter_______________-____Depth________________-_._--_____-_-_,V Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material___:-- .__._---_-.-.-_______--_-___- 11 ❑ Size: Diameter----------------------------- -------Depth---------------------------•------------- ----------Liquid Capacity--_----•----------------.ga's. Privy: Distance from .nearest well ------------------------________Distance from nearest building___ - -__.-------------------- Distance _.__ _ .--_--.Distance to nearest lot line----------------------------- ------------------•----------------------------------------- -------------------------------------- ---------- Remodeling and/or repairing (describe)---- --------------------------- --------------------------------- --------------------------- •--•---------- ----------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------- --------- -------------------------------------------------------------------------------------------------------------I-------•--------------------------------------------------------------------------------- --------•----------- -------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------- 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)---------- ----------------------------------------------- ----------(Owner and/or Contractor) By:--- -------------------.............. - - --------- --------_-------------------------- •----{Title)------------------- ------ ----------------- ------------ (Plot -- -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `' � ------------------------ ------------------------- DATE /`„' '_ y---- -------------- BY---------------------------------------------------------------- ------------------------------------------------ --•----- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-- ----- - ----------- -------------------- ---- DATE---- --------- ----- -- Alterations and/or reco mendations•. �N- Qa_K nn ---------------------- �'. __. R 4rl- -----'`tet f� D----- -----0 -1-- ----"7 c i�. � - G. r P_1_,VA /l<VSP � � - G----- /1(`aT64-4, 1> 5 5ff0w/V- _._ SP. uT... N. Q�I� p��RVI� ------------------------- -------------------- - --- --/�/-------- --------------------------------- FINAL INSPECTION BY Date-----------------�.7LY_7-46�j SAN JOAQUIN LOCAL HEALTH DISTRICT 5' 1601 E.Hazelton Ave. 300,.West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California fr�anteca,California Tracy,California