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FOR„OFFICE,USE: t --------------=----=----------------------------- ---- APPLICATION 'FOR SANITATION PERMIT Permit No. ..,[.. .L.. S -- -_3 -----.. ---------------- (Complefa in Duplicate) r... --....... � .. ,;.�„ Date Issued ----�._ ±�:.:� __ _.._,_-., ►��. ? _-. E,-'��This Permit Ex Tres 1 Year From Date Issued f ) 21f3- rzf� -oma 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. F C T JOB ADDRESS AND LOCA ON...rR+�'.----- �_1'-_��l A_RT_ Id-- � C1 1 � � �1n�C1 (f N C --------- ---- --------- Phone----------------------- Owner's Name5b -� Address-----•------ T -" f--='------B-ax--------- •----- -----------------------------------------------------------------------••---•----- t i Contractor's Name_4EF-�> P.1__I.0----- 7VK---.5 1 _I_ . —-------.. A449t> --- Pho a-•---•--------•-- Installation will serve: Residence ❑ Apartment House ❑ CommercialTrailer Court ❑ , Motel ❑ Other ❑ ff ;, Number of living units: -------- Number of bedrooms -------- Number of baths --- Lot size .......... -------------------- 4, Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _1Z ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑' Clay' [] Adobe ❑ Hardpan ❑ , Previous Application Made: (If yes,date--------------------) No Ell' New Construction: Yes (! "No ❑ FHA/VA: Yes ❑ No OJ _ _TYPE,OF INSTALLATION AND SPECIFICATIONS: z. - . --. ,-== - - �:.� - - (No septic tank or cesspool permitted if public sewer is available within 200 feejjt.) Sep�tic,/Tank: Distance from nearest well_._�r©---Distance fromfoundation-----!_U_-------- ateri I-_��1 G[ .> Tr=...____.____. u No. of compartments-------2=--------------5ize__ -X--- - Liquid depth__- �-.---------Capacity-----*1 12-----1 _- Disposal Field: Distance from nearest we31....�-Q__.__Distance from foundation 149 to nearest lot line; --------- Length -_-_---- Number of lines----- --_ -- Len th of each line___.____1JfJ_._ Width of french-------g ,----- �^p Type of filter mate rial-_�5_ �1_.___Depth of filter material----- _. Total length---------------la-.-____-.__,- I Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line-----__--_-_--.-. ❑ Number of pits----------------------Lining material----------------------.Siler. Diameter-;---------------------Depth____._.._..__.____.___._------ r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_._____--,__-_-.__-______-_._._--. ❑ Size;-Diameter----- ------------------ Depth-----------------------------------------------------Liquid Capacity-- ---------------------•-gals. Privy- Distance from nearest well-------------------------- -.Distance from nearest building____------_----------------------_ M1 ❑ Distance to-nearest lot line .-------------------------------------------------- ------------------------------------------------------- i Remodeling and/or-repairing fdescribe):___Ah?----IA1 DI 4 ii}t?_44__ -----LP TH_S- ISD-------It --------------------------------------------------------- ------------------------------------------------------------------ ------------- -- tl ------------------------------------------------ I ----- D ----- -- - - ----- - ------------------------------------------------ ----------------------------------------------- ' here6y certify that I have prepared this application and.+--a+ the work will be done in accordance with San Joaquin County` �m ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed] " { ---------- - --- Owner and/or Contractor y �- ------------- ---------- (Plof plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT VE ONVY77 i APPLICATION ACCEPTED BY------ _R_t_(-' --- A 14- � `_ -5 ----------- aI - --- -- -------- DATE ! -_� ---- i ------------ DATE------------------------------------------------------------ REVIEWED BY--------------------------------------------- ------ -- �- --- --- -�`�° - - --- - ------- BUILDING PERMIT ISSUED---------------------------`y- V--- ,_ = - DATE----- ------------------------------------------------------ Alteration's and/or recommendations------------------j -_ f -- -------------------------------------- ---------------------------------•----------------- -------- ------------ ---------------------------- -------------------------------------------------------------------------- - -------------------------------------- ------------------------------------------ --•------------- --- -------------------------------------------- --•----------- ---------------------------------------------------- -------------------------------- ------- FINAL INSPECTION-8. -- -- - ._-- _-- -- /��T� Date---------------- --`�-- -`- S SAN-JOAQUIN LOCAL HEALTH DISTRICT 1601 I:,Kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California