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------------ ------ -- --- ------- - ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. r--------------------------------------------------------- (Complete in Duplicate) ✓r- ----------------- This Permit Expires f Year From Date Issued Date Issued .__.__ �._,� v I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the I ork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._ ..._ -1� 4_ V._-___.____••_____•••.--• _NTF J •--------------------•-•-••••-----........ Owner's Name_ ` �F•>Y Qr'� __.. :.:_ _. Phone.... _ �,. _ -------------- Address._. //�� .�_. illf _- t _.r y•t..... Y�C� - fi - -----••------•---•---•-•---•---- -••----•--...-•--••-•-•••------•-•- •---•---._....-•---- --_t4 Contractor's Name. /1f _ --- -.--�•-----------------------------4"----- `"--................. Phone............................... Installation will serve: Residence Apartme t House ❑ Commercial E] Trailer Courtw❑ Motel ,❑ Other E] Number of living units:__..... Number of bedrooms Number baths ..-. lot'si e�.. :.,�_/Q__.x / ....................... Supply: Public system ❑ Communitysyst m ❑ Priyate epth to Water Table .Gi1... ft. Character of soil to a depth of 3 feet: Sand Grave! l Sand Loamy Cla Loam Clay Adobe Hardpan f � ❑ � �Y ❑ . Y ❑ Y ❑ ❑ p ❑/ Previous Application Made: (If yes,date;______" _______) No New Construction.: Yes �No ❑ FHA A: Yes ❑ No Lr 'wTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ��ic sewer Is vailable within 200 feet.) Septic Tank: Distance from nearest well-_,.1##_'-�-----Distance from foundation __,_.___-__-.Material...........I................. ................. No. of compartment---------_F ------size----1------------------------Liquid depth.......................... --------------- --.---- Capacity.... p IF ------ k from foundation_ ___.. .Distance to nearest lot line__-. r~ Disposal Distance from neare� �� _-,_pistgan � p �+1 , Ci"� Number of lines------- /; - 4_________Len the of each line_- -�Q.._ ��_ Width of trench____,- !V S-et-p/�} Type of filter material•_._. �C- -_Dopth of filter,matenal_____ ____-___Totallength................... ..__--___-__ J. R -�., �. y Pit: Distance to nearest well______________________Distance from foundation�'�_--__-__.Distance to nearest lot line__..___..-._...._ d. ..,_....y: - 1KY• i � i ❑ Number of pits-----:-_t'-----------Lining material-I_____.__f__�_ _Size: Diameter-..._-, -- �..Depth---------------- ............... f � f ► f l------------------------ ___ ...... Cesspool: Distance tenear"est well----------------- te from foundaton -- Lint -5izeDiameter Deth" rqud CaPari9-- - Privy: Distance from nearest well--A--------------------------------------------Distance from nearest building.--:_.-_ -----------------i ------------- Distance. ._-_ } ❑ Distance,#o_nearest I fi line ;�. _ " '{ - ° "- ._ __ - w� Remodelingand or 're airin describe --___ --�: LIC / P g l � ) � ------;�_.`-EVSiEj� ..__l.��f�l_:�--141�.±::�-----�� Q�lif -------Wt 11 1idt-) t 17�f�c�_r..._...rA a �? 13 I ,t}IC� :___ iVTt1 /7_46- , -- . ,_=,1?� 1.1 L------ .!W,c••c----1_N- �14�L-_.. � --- ��).�I�oc��.!nj?1��r� PR_o_. ' s �...---•�R1Q1 -----------------------------------------------------------------•--- ................................... '= I hereby certify that I have prepared this applica+io^and the th ork will'be do^e in accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r ` (Signed) _ '" r ( •g }------- (Owner and/or Contractorl 117 By: 1 - --------------•------••----------------------------------------------_{T'itle)_----------------- -T-�.:`..�.:.�'�_:- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMEN3 USE ONLY-4 APPLICATION ACCEPTED BY----------/ t-R-V- ----------------------------•---------------------s-------------- DATE------- '— rREVIEWED BY-------•---•••-----•------------------------------------------------------ -------------------------------------:------ -- DATE----------------------t----- ' BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE. :.: I...._._ ' Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------.1----------..-------------------- ------------ .. f 40-v,.rl�f.-------- t ' - --------'fiA K Cru i �izr + rT` IF Ar c � FINAL INSPECTION BY-------------- Date------------------- . r^-------------------------------- *1 IN LOCAL HEALTH DISTRICT 130 South Ameriean Streel 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 pM 5-61 AT LAB