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FOR OFFICE USE: ----------------- --------- -------- ---- --- APPLICATION FOR SANITATION PERMIT Permit No. --------'----------------- -- ----- - [Complete in Duplicate) Date Issued .A_ 1 � ................._-- .. This Permit Expires 1 Year From Date Issued I 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. j1 JOB ADDRESS AND LOCATIO '5----1 j7.[I±� , . w !r lu 4 `�--._ J;1'� T;l -N. _1 . Owner's Name----------- m rd-I --------P A-I-AH -------------------------------- Phone----------------------------------- Address.................J.73---....... .......... - ---------------M-3—*9-.-------------------------------._.....------------•-------------•-•--------- Contractor's Name----&WIV-Ell -------------------- ----- ----------------------------------------------- Phone.----- -------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + Number of living units: -1----- Number of bedrooms 1 .— Number of baths . -1- --- Lot size . -C �TKFA--6�---------------- -- -- Water Supply: Public system ❑ Community system ❑ Private Z-'Depth to Water Table /C ft Character of soil to a depth of 3 feet- Sand Gravel [] Sandy Loam E' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote--------------_-. I No New Construction: Yes ❑ No U]--T_HA/VA: Yes ❑ No 0✓ , —TYPE-OF;INSTALLATION-AN D-SPECIFICATI0NS:-- -- = - - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f0 Septic Tank• :570_ : Distance from nearest well..__ _ Distance from found _.. ._ __.ation__ _-----Material ---C_OA/(Js-•7[ ------- No. of compartments._._..:?:..........Size_1/!rf A_� Liquid depth----�_�-----.Capacity._-r ..-. Disposal Field: Distance from nearest well- 45V-...Distance from foundation.... .�..........Distance to nearest lot line.-2LI /e - J�xZffsj%!J6- Number of lines...._-.-.._-/--------------------Length of each line._ _.f6Q...-`__.. ... . Width of trench-------- I.... -f-- /)U17' Type of filter material_ PO C�--_Depth of filter material______��________-_Total length------------------60------------------- i Seepage Pit: Distance to nearest well......................Distance from foundation-----------------.-.Distance to nearest lot line----------------- f ❑ Number of pits.-- ------------------Lining material------.--. _ - --- Size: Diameter----------------- - ---Depfh-- _. ------ f Cesspool: Distance from nearest well -------.-------Distance from foundation___ ---------- Lining material-------------------------------------- Size: - ------._----------------_-.-_-.Size: Diameter. -- ------- ----- ----------------Depth. ---- ------------------------_------- ----------Liquid Capacity--"-------------- ---------gals. Privy: Disfance from nearest weh----------------------------------------..-..._.-Distance from nearest building=_::._ -------- ----------- ----- --- ' ❑ Distance to nearest lot line -------------------- ---------"---------------------------------- ----- Remodeling and/or repairing (describe):----- ..1 _C'.------.RFU_1 ..1r. a�xI rt -----.-S-'-- <•--------------------------- ---------------------------------------------------------- ----------------•----"----------------------------------------------------------- -- --- ---------- ........"----------------------------------------------------- --------------------------------------------------------------------------------------•--------------------•--•----------------------------------------------------------------- --------•---------------------------------- - ! - ------------------------------ I hereby cer . that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules a "regulations of the San Joaquin Local Health District. [Signed} ------- _ m [Owner and/or Contractor) y• � [Tltle) .----....----- •----------------------------------------- ----------------------- - - ---------------------------------------------------------- ---------------- - ----...------------------. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMESE ONLY APPLICATION ACCEPTED BY----- t R` ' ----- --------------- ---- --- - -- ----- DATE --��.�� ..1U7--r------------ ------- REVIEWED BY------------------------------------------------------------ -- --------- ---- ----- ------------ ------------------------- DATE BUILDING PERMIT ISSUED-------- -- ------------------ ------------------------------ ------------------------------------. DATE------ - --------------------------------------------------- --- - Alterations and/or recommendations:--- ----------------------------------------- -----------••---------------•------------ ----------- ----- ---------------- ----------------------------I---------------------------------------------------------- --------- -----------------------------------------------•--------------- ----------•------------------------- ------ -- ---------------------- ------- -- ------- ---- --- ---- --- --- - ----- ---------- ------------------------------------------- --------------------- ------------------------------------------ - -- -- --------------- ------------------------- FINAL INSPECTI Y:- ` ,f - . J Date - C� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,Californio Tracy,California E.H.92M 1-67 Vanguard Press