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rvlt+Jrric..t USE: z _ ------------------- ------------------__---------------------- -----.._ APPLICATION FOR SANITATION PERMIT Permit No. .r19 � - - ------------------------------- --------- ------ (Compl;-fe•in Uuplicatel c� ------ ----- -------------------------- --- This Permit Expires 1 Year From Date Issued , Date Issued _. C,_��_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the�work h reinldescrbed. This ap licatio is ade in co I' ce with County Ordinance No. 549. `r-f-,t RQ�73o ,. ,�. 5-r JOB ADDRESS AND LOCAT 5�Pg...... E _ �gRK----Er-------- t -------- Owner's Name------------------ LR&f_,s --------va�e� --------------- -- ---------- Phone------------------------------------ Address .----•--...-•----•---- - Contractor's Name------- U1_(�I lam----------- ------ -------- _ -------------•------- - -------- ------- -'---------- ---------------'---- -'---'--'--- Phone----------------•----'- ------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer 456g" E"Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms -2---Number of baths____1_ Lot size Water Supply: Public system ❑ CommunitW�Gravel t m El Private E] Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------- } No New Construction: Yes � o ❑ FHA/VA: Yes Q'+ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: - - - -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ink: Distance from nearest well--.__..��'_�._. W p _ Distance from foundationial ----CC.�1l11C-�_�-I--�..... O No. of compartments------- .--__----._Size--- _X1 ___ _ quid depth_ fir-.----.Ca acit ACU-- p Y --' Disposal Field: Distance from nearest well..__.5O___Distance from foundation,----fQ---_Distance to nearest lot line.--��,-• ©� Number of .W lines._-_______" ----------- Length of each line-_ __.� -0-- _"�_� idth of trench_.__'-- Type of filter material-_f Q.C_Y�..___Depth of filter material___-��_��.._______Total length__.____.__ © .- ----------- Seepage Pit:I'ifi: Distance to nearest well --- from foundation------------------- Distance to nearest lot line__._-_____..___._ ❑ Number of pits--- ------------------Lining material-------------------- Size: Diameter-------------- -- ----Depth-" -------- ---------------- Cesspool: Distance from nearest well ________________Distance from foundation ---------------- _ Lining material___.-- --------------------------- El Size: Diameter. __ --------- ----- ----------- - Depth-'----' ----- --"--------------------------------Liquid CapacitY----------------------------gals. Privy: Distance from nearest well__________________________ Distance to nearest lot line ___Distance from nearest building------------------------------------------ _._-- Remodeling and/or repairing (describe):---.-- --'---- _Q � J_ v ----- {�tl/� ----------•----------------------------------------------------------- ------------------------ --------------------------------------------------------------------•----------------------------------------------------- ----- - ------------------------------------- ---- - ------- 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 reguiations of the San Joaquin Local Health District. (Signed)----------- ----- --• ------------ _ "- (Owner and/or Contractor) By:_ - L ' _ ! _ Title - ------------------ ----'---- ------------------------ - -- (Plot plan, showing size of lot, locafi;46 of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME,NT-USE ONLY APPLICATION ACCEPTED BY------�r _ - '----------------L. --------------------------- ------------- DATE_... REVIEWEDBY------------------ ---------------- - -------------. DATE----- - -------- ----- ---------- BUILDINGPERMIT ISSUED-------- -- - - ------------------ -- ----------------------- --------- DATE------- Alterations and/or recommendations:.__-___.______ --------------------------- - - 7_-_� 77-------------' ' FINAL INSPEC - ------ � Date------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodl, California Manteca, California Tracy, California E.H.9 2M 1.67 Vanguard Press —