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r-UK Vf"1'C t u3t: - -------------------------------------------------------- c� ---- --- --------------------- ----.-------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. - ------------------------------------------------------- (Complete in Duplicate) f ----------- ------ This Permit Expires 1 Year From Date Issued Date Issued /.2--- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ficaf' n is made in compliance with Coun .y Ordinance No. 549. Jo o Z JO ADDRES AND LOCATION-----�V---- --_----------SU_z: ------- '-------------------- j��141JTT`E-C to . Owner's Name----------------J P-!`�- -- CORL( _1_P4..._ -------------.-. Phone.-------------- --------- Address------------------------_3__0--------- ------------ .1�_ [ rV-------------------------AmAa IQ--------------------------------- -- Contractor's Name-- L-L-EF1� ----------------- -------------------- -------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ `Motel El Other El Number of living units: j---- Number of bedrooms 3__ Number of baths 7Z_ Lot size -----/-5__0Q ----- - -- --------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table r7__ ft. Character of soil to a depth of 3 feet: Sand ®ravel ❑ Sandy Loam [ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application9 Made: {If yes,date....................I No,2---_New Construction: Yes ®--Ko ❑ FHA/VA: Yes tr_No ❑ TYPE OF INSTALLATION•AND SPECIFICATIONS: Zi 01- _ 11 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well --_-�0---Distanc from foundation-_l-C----_-----Materiai__50-/ C- ET No. of compartments...... , ,__.._._.Size__ /U(__1K- ^Liquid depth_ - � --------Capacity_._. ZL�- -- Disposal Field: Distance from nearest well...S -----Distance from foundation=_._I_. 9-._.__.Distance to nearest lot line_J-0._.__--. Number of lines------ Length of each line _ _... ___-_..Width of trench.___ 2_-_-- �- -----!! ------ jr Type of filter material- C.tG/ ,----Depth of filter material___ 7--___`______Total length_____ Seepage Pit: Distance to nearest weft______________________Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------.Size: Diameter---------------------Depth--------------------------------- Q Cesspool: Distance from nearest weil-----------------Distance from foundation------------------- Lining material_.___.....__-.__-___--_-_.._ - ❑ Size: Diameter-------------------------------------De Dept -- - ---------------Liquid Capacity------------ ---------gals. ` Privy Distance from nearest well----------------------------- --- -- ..........Distance from nearest building--__--_.______--_--_-_-__ V ❑ ;Distance-to nearest lot line------------------------------------------------------------- --------------------------------------------------------------------------------- Remodelingand/or-repairingj(describe :------------------------------------ -------•--,-------------------------------------------------------------------•-------------------------------- ---------------------------`--- _.._-------_____ � . s � i _____ _ _____________ ,._______.__._______„__._________._-----_-._-_---_-_-___-__--__-_____________._____.------------------------ ------------------------------_______.___.___________________._______________._...___. 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, and rules and regulations of the San-Joaquin Local Health,District. ned (Si g ) ll,�,, ff -_(Owner �'�J--- - --- - -------- --------- --- --- --------- ---------- and/or Contractor) $y---- =----- ----------------------- f-------------- - ----�------------------�`------(Ti tle) ------------ [Plot plan;showing size of lot, location of system in relation to wells, buildings, etc. can be placed on reverse side). R 4, FOR:DEPARTMENT USE ONLY, APPLICATION ACCEPTED�BY------.!__( .L .-'------------------;=---------------------------�3 4;}�,t DATE-- I/�_�_6.. ..�..� REVIEWED f3Y.--- w - -- - DATE----- _ 4, . 3 BUILDING PERMIT ISSUED I`./ - - -------------------------------------------- --------------------------------- ------- -- --------- ----- !�--_DATE--------- -------- Alterations and/or recommendations:-----AMT__�'-----C�LA/1!G_E-----/- ------+ -�H----'14-Ai—JE ---._AA_ 1�L7 ------------------------- ------- m-----ANS-------AL--S ------._�14AN6.E:�----1ttL h(1��-� ]�L� AT�1-v/V �'] ----------------------'------- ----------------------I----------- -'--..--------------y---------------------------------------------------------------------!_`A-----------------F_-a----"-S— ----------- I--------- ' �4 /k FINAL INSP ii1- ------ ---- - Date-- - - - - _ l -0/-/. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CD.