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KIR OrFFPCE USE: APPLICATION FOR, SANITATION PERMIT Permit No. ---------- ------------------------------------- ------------------- ------------------- ---------------- (Complete in Duplicate) ___ __ ___________ _---._.. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to c�QQn�sstruct and install the work herein described. This application.is.made in complia ce with County Ordinance No. 549. 7TH .2-57- /to-"Zz �ITCr� �bo/ S&7'Wo4(L/4 �- �# " k JOB ADDRESS AND LOCAT n , f NT p-�_ - VE-------- �Q ''L�---SD--�------ JOB ADDRESS AND LOCA�T1 Owner's Name------------- L-.I tq.-N -------------- l�_i_ _�,. -Q ........... ------ Phone------------------------------------ Address 2' I3ax..........1 Add ress-------------_ TES R Contractor's Name-------s : Phone Installation will serve: Residence ET_ Apartment House ❑ Commercial ❑ Trailer Court [3 Motel [] Other ❑ Number of living units: __/----- Number of bedrooms -Number of baths _/--- Lot size ------------------.--._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 15_ 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 Construction: Yes E /3 Vo ❑ FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic-tank-or cesspool per_mifted"if public sewer is aavaailable within-200 feet:)' Septic T nk: Distance from nearest well___50......Distann from fauns tion_--, ------.-.M trial. C'ONG -------- No. -=---- I [ No, of com artments___._�-. -_ ____ Size Li uid de th___� Capacity pX .-7-1-Liquid p. p Y v Disposal Field: Distance from nearest well--_50_____Distance rrom oundation--__- _.. f lQ_______.Distance to nearest lot lirie_____�S Number of lines_____________ Length of each line------ QQ__._---__ Width of trench______ .__ y Type of filter material----R_0_C.-K----Depth of filter:aoerial-----._-1c;?-______Total length- -------------------------- .t SeeDistance to nearest well__-----------_---------Distance from foundation:'.".................Distance to nearest lot line----------------- Cesspool: Distance from nearest well----------------- --'�� Size:•l7ierrieter______.__..._---_..._,yDept h------------------------------- ..� ❑k ,,,.,.Number of pits._,a__��___ -;rLining material r * p Distance from foundation_____ _..........Lining material,_____._.______.___.._._____________. � Size: Diameter------------------------------------- Dept h---------------------- Liquid Capacity gals. Privy: Distance from nearest well-_._____._.__-_ ._........................_..Distance from nearesft building._._-.------------------------------------ C 11 ❑ Distance to nearest lot line ---------------- ------------------------•------- ------------------------------------------ Remodeling and or repairing (describe)-----------------------------i ------------------- ---- - ----------I--------------- -----•---------------------- ------------------------ -•- -•- --•- - ------ RHs-j---------------�'----------------------------------------=------------------- ._._--__ __._---- --._- _rn---_----- -------------------------------__----______----- - - - k - ---------------------------------- ------------------------------------------------------------=------------------------I----------------- --------------------------------------- - --__ Ihereby certify That 1,have prepared this application nd that the work will'be done in Tctordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------- ------------------------------------------------------------------------------------------------------f---------------------------------------------------(Owner and/or Contractor) + T L _ _ -3 .--. - .......... . .. ......... . __. _ ---------------- .Title _- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). +-�- FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-------F---i-L1- ------------------------------- ----------------------------•----------- DATE---- _-_�y`. ( _---------------------------- ()' BUILDING PERMIT ISSUED--------- ------------------------ -------------- -----------/•-r--------/-�---------------------------.- DATE-- ---------------------------. REVIEWED BY--------------------------------------------- ------------------------- ----------- ------------------------------------•--- DATE------ ------- Alterations and/or recommendations:------- �_ �.-_-2.F.....1r��A. __._ /Y —._-_--._.--4"/ � / � __.___"�" 1 ------------- ------------------ 7 NK- 1z � o© C �, - . ------------ --------------------------------------------------------------- --------------------------•--------:--------------------------------------------------------------------------- -------------------------------- -------------- --- ------- -- - ----- Date.FINAL INSPEC --- ---- - -- ---- -- --- ` --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California k