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FOR OFFICE USE; „ -------------- ----------------------------- ._.. - .. ........ .-------------- . ......._ .. ___ ------- APPLICATION FOR SANITATION PERMIT Permit No. -------- --------------- ----------------•- ---- (Complete-in Duplicate) ---------- ------.-=. This Permit Expires I Year From Date Issued Date Issued 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 with County Ordinance No. 549. 407-JOB ADDRESS AND LOCATION--------162917-----------SPf314�_.CREFe-K----------------------------- Owner's Name------------------ �� t>9 �"� .�. ,L ----- _1�_- --------------------------------------- ---------- Phone.--------- -------------------------- Address r"1 t ---- --- VV ------------------------ ------M_ T_CA. ------------ } t Contractors Name tp1lr,Pt�,}.lE Phone - Installation will serve: Residence Apai-ti-n-grif House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:, __-. umber of bedrooms 5... Number of baths 7. Lot size .�_ODO_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .- .-- . ft Character of soil to depth of 3 feet'SandGravel ❑ San y Loam ❑ Clay Loam [] Clay ❑ Adol?e ❑ Hardpan ❑ \ Previous Application Made: (If yes,date..___-- _-._ I l No New Construction; Yes �o ❑ FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �,��-' {Noysep+ic-tank-or-cesspool permittewd-if;..p.'u�--bl.i.c-s- f.�e e++- Septic l k: Distance from nearest well....�_t___.. Distance from foundation.- M.. ate ial_.teo. Ya_ _ /iT_ ,oe No. of compartments......2 -------------Sizell /IT_x. . - -L-qui� epthCapcity--. Disposal Field: Distance from nearest. Distance from foundation..... Q �- .__. Distance to nearest lot Gne.....� Number nfxllnes.----- p `...----_.Width of trench-4-2 - -�--- T e of'filter material 04w&---Depth material - .. r ---------- Type Total length ----- ----------------------- I -� ------------ Seepage Pit.: Distance to nearest well Distance from foundation------------- --_Distance to nearest lot line.....____.-..._. r ❑ Number of'pits-------------------- Lining material---------------------- Size: Diameter----------------------Depth ----- Cesspool: Distance from nearest well----------------Distance from foundation.. _._ ......_ _.Lining material_.... ElSize:-Diameter. -- - --=- --- -------------- - --Depth--- ----------------------r------ 0---- . -...Liquid Capacity- �-------------- --------9a Privy: Distance from nearest well________________ ___.___.--------Distance fr nearest building-------------------------------- ❑ D] stance-to-rlearest-4ot-,lire - Remodeling and/or re,airing {€l scribe).... .... -------' ----------------- -------------------- --------------- ------------ - ,- ----------- ------ (_--------- � ------ ---------------------- - -------------------- ------------ -i------------------------ ------ - l hereb th P P - -- ---- - - - _ - ----------------- ----- - - l - - t�h haxe.,. re ared tis. pplication_and khat thework will be done in accordancewi+h Sen Joaquin Coun+y ordinances, e la nd ru6L an re ulons of San J uin Local Health Dist�ic+. (Si ne-d 9 ) = : _--------- �3 .(Ownerand/or Contractor) �$y.: R - - ----" =�—= (Title)-. (Plot plan, showing size of lot, location of ski em in vela+ion-to wells,.�buildings�fc..,can be placed on rrl erse side). I /FOR DEPARTMENT USE ONLY # APPLICATION ACCEPTED BY----.-_-_t DATE-- --------------------- REVIEWED BY-----!. 1 _. . - � _. . ,. ._..�D AaTE -"-.-�--- rt ---------- ------UILDING PERMI ISSUED- - - DATE-- ------ ------------ � -- Altera+ons and orl,recommendations 2 ,�,: _ ....... Pt TA ne- _ "e�K.- PP2. M_ Mr,_PAF�r_..4s_K ...t-E ---1`?RI - Jr,( ---Ocrrc-9ZT.._._.-.91443ayvr FINAL INSPEC N BY:._ r Date....... .r- .--_.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press