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FOR OFFICE USE: -- _ ----------- ----- ------- --- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ..02D__. ----------------- -- ------------------------ ------- (Complete-in Muplicate) Date issued / ______________ _____....._-------_----------- This Permit Expires 1 Year From Date Issued ____!,17 Application is hereby made to the San Joaquin Loca€ Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ord* nce No. 549. } JOB ADDRESS AND LOCATION "=�� _�-`--- 1 `= Owner's Name------ == __ r _ _ 'i r: 7_I 1 _ :-. '� I3_ A Phone------------------------------------ ::_ :� 'g t -- -------------- ------------------------------- ----------------- Address- ___--_---___ 1�_ � - Contractor's Name-----QW11I-W-Rk--------------------- ----------------------------------- -- - -- ------ -------------------------------- Phone----------------------------------- Installation will serve: Residence [ii--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./_._._ Number of bedrooms Y--- Number of baths-3— Lot size -------------__._____- Water Supply: Public system ❑ Community system ❑ Private[Depth to Water Table ------ - ft Character of soil to a depfh of 3 feet•: Sand ❑ Gravel ❑ Sandy Loam', C,lay Loam"❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,ciate_-.-.... 1 No E�New Construction.: Yes La- No ❑ FHA/VA: Yes R-"No ❑ —..,,�,.-TYP_E-OF_INSTALLATION4AND. SPECIFICATIONS:.=.-�" -- K - - ,.� ,.- -------------- (No ---(No septic+ank"or cesspool permitted if public sewer is available within 2 Q feet.)_. µ No. of com artments '_ ._ Size_,' - - __Li Liquid Maferial''-P�. :1 _��/ ...__. P� P ----- - -- q id depth- - Capacity--- --F Septic Tank: Distance from nearest well... Distance from foundation--. Disposal Field: Number from l t nearest weII SU?;7_5en th of each luedat� _. '_�' _..Distance to nearest lot line__S___-_____. p ,: !I -------- L�' 9 - - - ----«--- --1Width of trench----- -------------►- Type of filter material-__ft C; .....De Depth of filter material----./..c�_ Total length---------------'.�0�_ ..._..__-- {� P F -. Seepage N+:Lj-'491Distance to nearest well..... "'�is�ance from foundation__-----------------Distance to nearest lot line-- ..._._------ of 1�-- mater al ,- Size: Diameter^~-i- -------❑ 'um' - Depth - - ------------- Cesspool: Di ,tner, _ terial . . ---__________.._________.____._ id Capacity gals.Size: Diameter. _ ._..- ... ---- .-.Depth- ----------------- ----- -------- Li u Privy: i Distance from nearest well---....--------------.--------------.:1._.....a.aDistance,from_nea"rest bu'i�din __-•_-- _ ---.-------_----_----._._. r =v ❑ -- - Distance to nearest ,lot line --c-; - Y`.�,.1 1` :� 1,, 1 -7 t' i. i Remodeling and/or repairing Idesc`ribe}�!% ,3 -----�J --- -------- -----------------•--•------- ----;----- - --------------------------- r -- ------- --- 1 w _ -------------- ------------= ----- 1 --------------------------------------------------------l + .------------- ------- - i"`_ _ _.r - --------•------------- —_ -"`""``y` - - - -----'` ------------ r' I hereby certify that I have'"prepared this application and that the work will be done in ac or&ince with'-gan Joaquin County ordinances, State laws, and°'rules and regulations of the San Joaquin Local Health District. ` L i 11r ., (Signed)°, $"__ _ F . �.(Ow'erband/orContractor) '! I � n "-r---- � , .�_..� >_ - }{�I e) _ : -- ---- ------- yr Y•------------ ----- - -• -------- ---- --- ---- - �--- ;- '� t Ge a l;�. (Plot plan, showing size of lot, location of sys+em In relatiln to wells, buildings, etc., can be pll dnevere'side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.-- _ .. Jr'. ------/--- -"-----=i----------------------- ------- ------ DATE--------- ---;?�10� .! ----------------- ti REVIEWEDBY----------------------------------- -------------.-------------- ...... ----1---------------------------- ------ DATE----- ' ..------......-L ----------------------------- - --- BUILDINGPERMIT ISSUED--------- --------------------------------=-- = -----------ice --------------- --------- DATE--------i'----------------------------------- ---------- -- Alterations and/or recommendations.- .....NOC�_ .'_C�.Z G - 1 --------- R D. ---*--------- ------------------------------------ _ =- `t --------- ----- ----- o t _ as •,., --------- •----------- -- •-------- - - --- - FINAL INSPECT[ --------. --- ---- - ------ ---- Date -`_L/_ _.. _ •_ ... ... . ... ..... ...... _ ...___..__.....____.._..__..__,. 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67. Vanguard Press ' � i