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FOR OFFICE USE ' APPLICATION FOR 'SANITATION PERMIT permit No. ..... .....:..... -- --------------------- (Complete in Duplicate) Date Issued ___ ___ __ �' • _ This Permit Expires 1 Year From Date Issued s Application is herebymade to the San.Jb0quinFL-ocal Health District for a permit to construct and install the work herein descried. f This application is made in compliance with County Ordinance-No. 549. `f --------------------------------------------------------------------- JOB ADDRESS AND LOCATION------ _ -r== ---------------- --- � ---------------•-------------- Owner's Name-------------- P,f _- C°- '�A f--/---�- ----- ,,f one----- --� --- -. P i �f4 �lf � /."�'!' �• --- ---------"-'------------ Address__..-•------•----------- ------•------ ----- a /j -- =-°-`--°------'----------=-- ----------•--------------- Phone----------------------------------- Contractor's Name--------------------------- rs?_E'er-----------"-=------------ •:� , !. Commercial ._ Trailer Court ❑ ,•Motet❑ Other Installation will serve: Residence [t]�Apartment House ❑ ❑ ❑ .1 A t Number of Irvin` units: Number of be "." Number of baths -�(---" Lot size .___.---- -- j I g �'- <- .1-F t - .. Water Su,ply: Public system ED/Community system ❑ Private ❑ -Depth'to Water Table -------- ft. .. Character of soil to a depth of 3 fest: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑Hardpan No El a } No New Construction: Yes ❑ FHA/VA: Yes ❑ Previous Application Made: (if yes, ---------------date-. ... I 'i1t s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] 4 Septic, Tank: Distance from nearest well_______________ _Distance from foundation.-___-.-___..____.Material___---.._-_..__._..""--._._--____._ ------------ i f7110� No. of compartments-- -- --------------------Size-------•------------------------Liquid depth-------- Capacity Disposal Field: Distance from nearest well-.._.-._.-____":Distance from foundation............ .....Distance to nearest lot line___. _._.______. .: l�tS��114 Number of ling` --------------------------------- Length of each line---------------------------- 14 ------- ----------- -------Width o trent ------------------------ ------•-- C TYI;e of,filter mP. aterial----------------" ---- --Depth of filfer material__._.____-----"-�_---Total length Dis#ante to nearest well___ _�Distance from foundation___________________Dlstance to nearest lot Gni----____.__.-_._ g R C s� X .C/PDe to Number of ------r -------- -Linin material----i --�- \---Size: Diamete� -- - - - p Cesspool: Distance from Diameter nearest well----------------Distance wjq"o�u`�ndat -=-0-" - -----Liqurid Capacity----------------------------gals. ❑ Size: r ------- --------------------------Depth -------- ------ Distance from nearest building"..--..___-_-._------.--___ __.._..Privy; Distance fromlnearest,wellt_.��L -------- Xr w -- F --------=------------- Distance o nearesto i ---------------------------------------- Remodeling and/or repairing (decribe]:_..." r -------- --------------- ------- - ----- --- - # ------------------------ - r, ----------------------- -I, 1 I hereby certify that I havepreparecl this application and that the work will be done in accordance with San Joaquin County l ordinances, State laws, and rules and regulationvf +he man Joaquin Local Health District. Owner and/or Contractor] Si �L ( 9ned} , f gY . .( --------- ---------------- `----- -- (Title) - _.... ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). I r FOR DEPARTMENT USE ONLY ' DATE----- �= ,�^- i�t'`f ---------------------------------- APPLICATION ACCEPTED BY-------? t ----- DATE--------------------------------------- -- ---•----•------ REVIEWEDBY----------------------------------- ------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- -- --------/--------- ------------------------ Alterations and/or rtcomrgendations- -------- ---- ------ -- � i� � - 7 - --------------- -- --------- ----- --a _ - - 6. - ---- /y � 7----,�IZ��E�� "` ' ��,,((�� -✓to-- _ } FINAL INSPECTION BY -•"� Date--------------------% ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT € � 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Lodi,Ca«farhia Manteca,Colifprnia Tracy,California Stockton,California F.P.Cp- w ..