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i"•bR OFr[CE USE: l I _ ...�• ---------------- --------------------------- ----------- 'a -------.._.., -- ------- ---------- _- IM APPLICATION FOR SANITATION PERMIT Permit No. .....____�-,:_.__...._. (Complete-in Duplicate) Date Issued ,� 3/-6 - - -_. . This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549. .. JOB ADDRESS AND OCATIhlO --_ '_.1�z$-----�UA)A1YS-IDE--------------------------- riC�Q - --- Owner's Name---- 1 ---- f CC�Q Phone.. - --- ---- - ------------ Address---------------------�M..E..I6--•------ • - -- -...------------------------.-..------------ P qq -•--------- - 466-96v Contractor's Name. .! /y-' ��`� S).. 14?C - --------------------------------- Phone.. _---------------------7------ i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unitsaI----- Number of bedrooms --2.-- Number of baths-1-.... Lot size ----- --- _______ ________ ------------------------------- Water Supply: Public system : Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes date_...._.. ___- 1 No New Construe+ion:. Yes ❑No FHA(VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 Septic Tank: Distance from nearest w_ � tom foundation---/`12--a---_.Mate fal..__ - M. INoof compartmentsr __ -------- (-Size ' _A' CLi uii_Z. a a-c ----- } Disposal Field: Distance from nearest well N40/1 _Distance from foundation___aQ_.~.._.Distance tC~mar t lot l ne_AJ__.__r__. n . Number of lines _� n__ _1 _.- ... + Length of each line-��1__--_€ __ Width of trench?____.________ _ MN Type of filter materiai_QG$L- ##_Depth o er tonal___ , :.. :Tofa length "_____ _.___. Seepage Pit: Distance fo nearest weTlIO �E..___I-Dist ce rom f h a, on_. 7�_ ___.Dista ce to nearest lot line_--�._.."�___ Number ap p+ts--��- ----.-._---Lining mate ial-_ -.- -----..;. �^Si"e.' iameter_ _X_ Depth---- --p---------------- Cesspool: Distance from nearest well .,.________-_Dist e from,f dation ...._ '_ ..Lining material--___________________________________ ❑ Size: Dia Diameter -Depth--------------'..- -------------- Capacity----------------------------gals. Privy: Distance from nearest well-_______.-....(__--------------......_.._. nearest:,'building.__--____.__.._____._________ .,i ❑ Distance to nearest lot line ------- I---- -------------------- -----`------- _ -i ------------------------------------~---` ' S t � Remodeling and/or repairing (describe):_. - ----------------- �-`� - ----- --L------Y-`---- - • ------------------•------- ------------------ ------ ------------------------------ ---•--------------------------------------------------------------------------------- 1 l --------- I� ------------------- d t° - ------ ---- --------- • t.. t ,•rl`hereby certify that I have prepared this application and that the work will be done in accordance with San�JoaguinCounty o�dinance5, State laws, and rules and regulations hof th} San Joaquin Lo al Healthistrict. (Signed) .a. �.k(lASW__ _. d]f�] Pinrelation s ... -------------- ----- Owner and/or Contractor Bn _S owin sae-tit lot `----- -r ------...... ---------- -----(Title)-1--P�SLb60JT-------- --- ------------ (Pant plan, g ?'location of syste to wells, buildings, etc.,LFcan be placed on reverse side]. ,,. y 1 1 + �f FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY -------- -��` -------------------------------�: ------------------------ DATE � -��-�'------------- ----------- REVIEWEDBY.------------------------M - - ..#.. ------- DATE------------------ -------- BUILDING ----- - BUILDING PERMIT ISSUED---1j!___----- -----------------------------------i------ ---------------------�-----------------1----- DATE--------- ------------------- ----------- ------------- iI Alterations and/or recommendations------------------ ----- --------------------1 _< - ------------------------------------_--------------------------------------- ---- -------------- -----------------=------------ ---•--------------- ---------•------------------------------- --------- -- ---------- -------- --•-------_---------- --------------- --- ----------------------- ------ ------------- -----'-- ------------------------------- --------- ------------------ ------------------------ I ----- ------ -------------------------- --------i I ( -. . ._ ( --fib._... I -------- j ------------. - ---------------- IN FINAL INSPECTION BY:_.-V.1)-t_--LS-----VrW_.. .--------I-------------- tiDa#e -- ------------------------------------` SAN JOAQUIN LOCAL HEATH DISTRICT + 1601 E.Hasaiton Ave. 300 West Oak Street 124 Syca�moreiSTreet 2-05 W.est„91h Street-1— Stockton, treet-1 - Stockton,California tLodi, California Manteca ffCaliforni�t =c racy, Colifornia E.H.9 2M 1.67 Vanguard Press �. i 1 f i +' d i