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FOR OFFICE USE: '-----------'-------- ----- ---------------- - APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------- ------_----------- -2.1�-.- --1�� ' ----- --------_------ ---_---- --- ---- --- -- {Complete in Duplicate) Date Issued- 5` ----------------- _--.-____----_-------------- ------- 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 Fade in compliance with County Ordinance No. 549. 2�-p¢Q•-C7� ADDRESS AND LOCATION �-- -------- ----- JOBf C�+ ' -1Ofai j � 1 / L -F_4 ._.VS-Q2 Owner's Name------�1--'----�/!'ca`7l? �r ��---� _ i _/--__�fl ✓�__-------- Address - - --------- Phone _ Address----- -- -------------------------------------------------------------•---------------- Contractor's Name------ VZ �-- drr h.. m. , C� `--------------------- --- Phone.. _ --•- 7�" t��t' y Installation will serve: Residence Apartment House ❑ Commercial. ❑ Trailer Court ❑ Motel ❑ Other 1 1 Number of living units: ---4. Number of bedroom-'`�.._ Number-of baths _-_i'.._ Lot size ____- ' --------- s Water Supply: Public system ❑ Community-. em ElPrivate Depth to Water Table _4i�ft_ Character of soil to a depth of 3 feet:"Sand_.❑ 'Gravel ❑Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ! Previous Application Made: [if yes,date'___________________) No New Constructrion: Yes No El FHA/VA: Yes ❑ No [I ti TYPE OF INSTALLATION AND.-SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.).' Septic Tank: Distance,from nearest well______--Distance�from foundation-_-ll�__��_-____.__Ma ria �- -------------- t ® No. of C"ompartments:_�F�_-- SixeI U -------------Liquid depth----� ------Capacity-----�� -f; Disposal Field: ,;Distance from nearest well__/W----Distance from foundation--_l��-----t---Distance to nearest lot lily_____— .:- Number of lines--------- --;--- -- ---Lerigth of each line------ - ----.Width of french----- `____________ ------ V _____ Type of filter material x --_.-_Depth of filter material____.--, :_Total length-----�,;�c?-----— ---------- Seepage Pit: Distances}o nearest well X::,___fi_" r Distance from foundation___________________Distance to nearest lot line________ _ P - -.- •. 9 material-----------------------Size: Diameter------------------ ----Depth------ ----_' � N ❑ Number of its-------------- L-in n' --- ----- Cesspool: Distance from nearest well:_. ---------Distance from foundation................ Lining material--------- --_-.___---___.____._--_.P ❑ Size: Diameter----------------- ---------------Depth- ---------------------------------------------------Liqu;d Capacity- --------------------------gals- Privy: Distance from nearest v;bl1__.F--------------------------------------.--------Distance from nearest building-------------.----______-_---------__--- ❑ Distance to nearest lot Line--------- - --- ----'----------------------------- ------------------------ Ion Remodeling and/or repairing (clescribe}:____�e��17�f[.1-__. -�T ---- r_' ' - _ ar`(�y--'----.----------------------- � f ------------- -------------• = --------- ------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------- ---------------- ` 1 hereby certify that I have prepared this application and that the work will .be done in accordance with S"an Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Heralth District. i �- { <<-------------------------------- -------------- ( caner and/or Contractor) (Signed) -' = -r By: ------------•-----------(Tit3 "` - e]- (Plot plan, showin size of7 cation of sysfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY -- - - -----------------------`-------------------------------._ 'DATE------ �r 1 - REVIEWEDBY = DATE------------------------------------------------------- - iytj DATE----------------------------- ----------------------------- iBUILDINGPERMIT ISSLIED------------- ------------------ ---`--------- ------------------.-------------------------------- ;Alterations and/or recommendations---------------------�------------------------- ---------------------------------------------"-----•---------------- 1 - _______________________________________________ • _____________________________________________________________�_•-__-____._-__.__.. ____________________________________ ____________________________________________________________________ i __ ____________ ____-------------- ------------------------------------ _____________________________- ____-_-_ _-----._-_-__..._ -_-.__.-.____..--------_--------------------------.___-----__------- __....---____._.._...__.____--._.._____----_._____ 4� ---- -----------------1---------- ..---------�--�--�- _ �- �_ � I FlN A r ---- ----------- Date AL INSPECTION BY---------- --- --• � --- --------------- - '� SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California f Manteca,California Tracy,California F.F.C9.