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FOR OFFICE USE: r ------- --- ------ --- ------------------------- -- --- / ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .t�. _-__.�f1 j (Complete-in Duplicate) Date Issued -- - �. ______________________._..--.-....-__-.._-..----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. Tli application is made in compliance with County Ordinance No. 549. JOBADDRESS A C ION..: - .- .----------1✓ ��------------------------- ------------------------------------------------------- Owner's Name-- ---------------------- Phone.---------- ---------- �------ - 'c,�-~r -- Address r- 77_ -`_ M Contractor's Name .� -- - ----- ------- ---------------------------------------------. Phone------ --------------- ----------- Installation will serve: Residence U��partment House ❑ Commercial ❑ Trailer Court ❑/ Motel Ej Other ❑ Number of living units: _/--- Number of bedrooms ---- Number of baths-- __ Lot size 10-_.- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableae-"ft Character of sail to a depth of 3 feet- %Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ W Previous Application Made: (If yes,date------............. J No W��New Construction: Yes Zj--No ❑ FMA/VA: Yes ❑ Nom, ki TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v Septic Tank: Distance from nearest well------ -_-.-Distance from foundation----i._L --------Ma��ial1a,- 'e�j --....-.- U5f No, of compartments-_,9_---.----..----Sizes?X€?-_-}�J� .Liquid depth- e*..--___ __.....Capacity ---------- Disposal Field: Distance from nearest well---....`' .........Distance from foundation---/°a Distance to nearest lot --- �]/' Number of linesy..------Z_.__�q------ -------Length of each line-------RV_"_",.-.-.Width of trench-. .... -....-_____._--------.. Type of filter rlaterial.-I_� �'WDepth of filter material---��_________Total length--..-'�---------------------------- r t Seepage Pit: Distance to nearet well......................Distance from foundation------------------- Distance to nearest lot line_.------------._ Number of its.- -Lining material------------- . Size: Diameter----------------------. Dept k- - ------ ---------------------- Cesspool: Distance from nbarest-well""-"-4`-___-Dfttance from foundation................. ..Lining material -_..__---..-----.-.----------.--_.- ❑ Size: Diameter_ J -------- . - Depth-------------- --------------- ----- ------Liquid Capacity------------- -------------gals. Privy- Distance from nearest well---------__________�__-_._----___.-__.-._.....Distance from nearest building------------------------------------------- ❑ f. Distance to nearest lot line --- ---------1 - Remodeling and/or re airin (describe):....__ r ------------------ - ------ ------ ------------------- -----� �r-----li1°� h f = _ .,. I hereby certify that 1 have prepared this application and that the work will beldone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- ............. < a %� rf�� / ------ -- ------------- - - --(Qwa*m=%dp6Pr Contractor) 8Y= ----------------- l - {Ti+le) (Plot plan, showing size of lot, location 6f syst in relation to wells, buildings, etc.,!can be placed on reverse side). PARTMENT USE-ONLY—A APPLICATION ACCEPTED BY--------- ---- ---- ---------------------------------- --- -- ------- DATE------ =1' j —------------------------- REVIEWED BY---------------------- - ---- -- --- - ---------------------------------------------------- DATE------------------- -- ----- -- - - -- - BUI-LDING PERMIT ISSUED-------- ---- --- -- ----------- --- D . Alterations a or reGommendat ns:-------- ._ ._ 1 t ----------- �`Cf� '' - f G1 Lda�LF j�y�` 0.71--- C'l�f 11 �_ � - ----------------------------------- ---- ---- ----- -------------------------------------------------------- iv ------- — ... . ...... -----#300 -- `- -- ----- --------- ;-:---- ----------------- ---------------------- - --------- -------- ------------------------ ---------- FINAL INSPECTION BY:- - Date - wry A LOCAL HEALTH DISTRICT 1601'E:-Hozelton Ave. Oak Street' 124.5 camore Street �� ,w r K 205 West 9Th Street Stockton,California Lodi. California ' Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press