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FOR OFFICE USE '" r ---------------- -- --- ------------ / -------"--"--------"--------"---------"---"-------------- APPLICATION FOR SANITATION PERMIT Permit No. ... _f1___. . --------------------------------- -- -------------------- (Complete in Duplicate) d� Date Issued _ _ Application is hereby made to the San Joaquin uipneLoctal Health Districtt Expires 1 f roam Date Issued pp y qpermit to construct and install the wor herein described. This application is made in compliance.with County.Ordinance No. 549. JOB ADDRESS AND LOCATION_-___=_ (-D/1�- - --------2 -------N---1 ------t -RR-IVG _------- SCA e Owner's Name---------kr-O–vN.------........ ----- 7 ; Q '------------- ----- ----------- ----- -- ---- ------- Phone------------------------------------ Address-----------•......E-0 13.0. ...... S-------- eSCR L ON. - ---------------------- - Contractor's Name ---UE-_-DJRT;T f�'Itr f - Phone Installation will serve: Residence Apartment House E] Commerc lI ❑ Trailer Court ❑ , Motel ❑' .Other ❑ Number of living units: ---!---- Number of bedrooms -�- Number o-baths ---_-_ Lot size _ _` -2.--.�L..-_ .©- 4 Water Supply:–f ublic4system•❑ Community system ❑ Private Dep h to Water Table3.gr ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loa`Clay Loam El Clay E] Adobe L] Hardpan r £ Previous Application Made: (If yes,date--------------------) No W---_`New,Construction: Yes t.l leo ❑ FHA/VA: Yes 8`' No ❑ TYPE,OF INSTALLATIOIN_ANp.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well--6------Distance from foundation----/_Q-------Material---CV(Z--RET`s 17)D No. of compartments------- --_.--.-.Size _ - - - iquid depth--_ ------Capacity- Disposal Field: Distance from nearest well------5—0 .-Distance from foundation----j9_-------.Distance to nearest lot line,--- Number of lines.--.------ A a��---_A%+ .Width of trench-___--2__---4-�6_. ,,C �.----- --- -- Length of� ti -- Type of filter material-_- - .�---.-K---Depth of filter material----- -_-_Total length-------------------Z__,- _----_-.- M Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- C El Number of pits----------------------Lining material---------- ---- ------Size: Diameter-----------------------Depth---------.----.__-_-----_------- v ' Cesspool: Distance from nearest well_-,--------------Distance from foundation....................Lining mate�ial---_---.-------.--.----.---_-__-.-._ �. [❑ Size: Diameter--------------------I_---------------Depth------------------------t--------- -Liquid Capacity-...-----------------------gals Privy: ------------------------ -----------------Dis#ante from nearest building------- _'�-- - ---* Priv Distance from nearest well--------❑ Distance to"nearest lot line------------------------- --------------------------------------------- --------- #-- r 1 Remodeling and/or repairing (describe):_------- ']Ft r ---- — M/� ----- f�------Qs,KF„-.` '--,--,1� .Q -) Z --------- -- -----• -------•---------------------------------------------------------------------- ------------------- # l ° -------------------------- �o --------------------------------------------------- --------------------------------------------------------------------- ---------------------= -------- ---jg �+ �,:._ ------- I I hereby certify that I have prepared his application and that the work will be done in atcordance with San Joaquin County d ordinances, a laws, an rulesVanda afions of the n Joaquin Lacal Health District.(Signed} ------- ---Z---- ---------- ------ ------- ---- ------ ------------------------------------------------------ --------------(Owner an Contractor).. Piot Ian, showing size of lot, location of system in relation to wells, buildings, eft., can be placed ed on reverse . T -'- T _ r �. ( P 8 � Y 9 P i side). FOR DEPARTMENT USE ONLY U APPLICATION ACCEPTED BY------- ---iBJP '------------------------------------------------------------------ DATE--------- -_77 5 REVIEWEDBY----- --------------------------------------- ------------------------------------------------------------------------------- DATE----------------------------- ----------------------------" BUILDING PERMIT ISSUED----------------- =-----------------------= = _------------------------------------------ DATE------------------------•------ - ------ Alterations and/or recommendations------------------------------- ------ - --------- .._... ------------------------------------------------------------------------------------------------ . �&A � .i%-. ' I r ---------------------------------------------------------------------- ----------------------------------------- --=•---- -------------------------------------------------------------------------------------------------- ------------------------ ------ -------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- r-: - . °------- % FINAL INSPECTI - -- --- ---- Q ---- Date- ------ ------ r J --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED B-59 3M 3-'153 F.P.On. -