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FOR OFFICE LYSE: - ' ................................ __.__..- APPLICATION FOR SANITATION PERMIT Permit No. .. _1 .�.��. --------=--------- --- ----------- ------ (Complete-in Duplicate) I ----- -- -------------- ------------------------- This Permit Expires 1 Year From Date Issued Date Issued .1 , 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. JOB ADDRESS AND ��//LOCATION_.-_��Q-�_�f4_+_5------SL�_�T�---- ��--------------------------------- C�-��Jl�-,------ Owner's Name 1►1( t-T --------I)a-- L.eT.�"Y.k"4----------- ----. Phone------------------------------------ Address------------ Contractor's Name-_ C$ n( ? T'_. G oAi- c A. - 712r. "F?13VE Pte_. Phone MapFSTO Installation will serve: Residence Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel E] Other [j S2 77/ Number of living units: -1----- Number of bedrooms__- Number of baths./----- Lot size ---14RETA& -.t--------..------------- Water Supply: Public system ❑ Community system ❑ Private Depth t9 Water Tab-I.b33 _ ft lt41 Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam R< Clay Loam ❑j�Clay E] Adobe ❑ Hardpart� :: Previous Application-Made:-(If yes,date_::_ -------) No- New Construction: Yes o❑ -FHA%VA:Yes yN�❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 a Septic ink: Distance from neareist well_..' Q......Distance-from foundati _._/1 ----- _..�M/age ;al ___ U/1/fkRE� __---.-.-_ No. of compartments--.__ ---.__.._._ Size_ Q. -Liquid depth / - Disposal Field: Distance from nearest weft- `-` 0....Distance from foundation_----et�. -' istance to nearest lot lineae--145 Number of lines ____k-_ --..__Length of each lin _ d g -}._.Wi th'of trench / Type of filter material._ _. _� _�___Depth of filter material____.�_.___1__.Total length---_------- -._-__-.-.-. Seepage t: Distance to nearest well77/200 itis nce from foundafiion ._.Distance to nearest lot line_ -T R Q �. Number of pits... _: -._ g C.----- / _--- __-. Linin materia1__i7tP._ �-.- Size: DiamEter__ _-- = '__Depth _. Cesspool: Distance from nearest well -----------_----Distance from foundation_f. _ Lining material----........__..-___.____-.._____.__. ❑ Size: Diameter. p ----------- ......... �, ------- .Liquid Capacity----------------------.....gals.------------ ---Depth { Privy: Distance from nearest well_________________ ___________________ Distance(�'om nearest building f„ tg... ---------- W ❑ Distance to nearest lot line------ - '.- ,- i -- ------------------------------- --------------------- _ _1 �A Remodeling and/or repairing'(descril �:~ ;� f /�" �Nf�� s(.�f�F--��__---F�y�--------- ,s�# ------------------------------------------------------- •------------------- -----V6�------.-W..I7rH-----A------4A_�4�A�1` --------------------------------- ------------------------ ---------------------------------------------.r- K0 ------- - 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, nd rules and regulatia of the San Joaquin Local Health bistricf. - _(Signed)_,-_ _- dV1 - -- ' Owner and/or Contractor) -- BY: _ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .tl�_-�------- -- --- -------------------------------- ------- ---- DATE-------- REVIEWED BY---------------------------------- - :; DATE BUILDING PERMIT ISSUED-------- -- -------------------- - ------------------------------------- DATE - '�` -d y' a" - -------- Alterations and/or recommendations:-.*s�`�,a....:..........r�C_1� '_ ._..- f ` ----- �-'T 4------ �t.«� -0 � - ------ - ---- --- - ----•-P17�---- --�'/G.��.f��_"!Ell1.T"k1 ---- -------------------------------------- ---------- - ---------- - •---- ._ ----- -- --------- -----• ----- - ---------- - ----------- -------------------------- -------------------------------------T..-------- ---- ----------- - - --------- ----- ------ -------------------- ....._... . . `T R.�. ` FINAL INSPE ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT s 1601 E.Hasollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street _ Stockton,California Lodi. California Manteca,California Tracy,California :E.H.9 2 1-67 Vanguard Press 1