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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.f L,! :T- -__.- ------------------------- ------------ ----- -- ------- (Complete in Duplicate) _ This Permit Expires 1 Year From Date Issued 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. /Ds—(00— ob ADDRESS AND LOCATION- f �` ��L/ND N t� DVAI---- JOBU I1C----Al "" '-'=A`'`�-- Owner's NameG� rF -- s �----rm1p--- /Il__ 3wN__T '�t/__ '`. iyT_ TA!/_. P�€p ---- --- "ND---- { Address--------�i I'-'�"-3 _ J1F- 11:7-7--'- 1 0-(7 ----------- 's �Z Z-------- ` ,f1I Q,G/ -_ C.� _ s-- '��• Q r� / (!�/ '------------------ Phona�-ro_7.F�r�------- Contractor's Name---------------P__A � C Installation will serve: Residence 2�, Apartment House ❑,� Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms _v Number of baths J---- Lot size __._S __._ =--•--------------- Water Supply: Public system ❑ Community system ❑ Private �& Depth to Water Table 70 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 E New Construction: Yes ❑ Noj>��FHA/VA: Yes ❑ NoK 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 foundafion------------.------ I -------------- , Material_-.-.------_-.-.-_______ __--_----_---------_-__. ❑�xis4/ No. of compartments - Size---------------- : -`Liquid depth---------- --- ----Capacity----------------------- •� Disposal Field: Distance from nearest wel4------ ..........Distance from foundation--------------------Distance to nearest lot line----_--.._--__--- ❑6xis411116' Number of lines-----------------------------------Length of each line--------- ----------------.•---Width of trench-------------- ------ y Type of filter material-------------------------Depth of filter material--------._____-._�.-Total length---------------------------------------- iarest Pit: Distance to no well_. -------Distant from undation---$�-_----: istance.t9�nearest lot line_____._..____._ 111 , -Z-of pits.r'��-��)-Lining materia{.�_��__ .`.Size: Diameter_.___.___._._-__.-._-Depth__.._. -__ Cesspool: Distance from nearest well-----------------Distance from foundation--------._-.------ Lining material--------------.---_.______------.-_i i ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid gaIs,.'1,,j_ Privy: Distance from nearest well-----------------------------------------------_Distance from nearest building------------------------------------------ I 0 Distance to nearest lot line------------------------ - ----------------------------------------------------------------------------- --------------- ---------- -------------- { - - Q - --------------------- ---...Remodeling and/or repairing -- ` - ------- ----a -----------------------------------------------------------••-•----------------------•----------------------------- - ------ ----------------------------- - ------------- ---------------------------------------------------------------------------------------------------------------•------------------------------------•--------- --------------------•------------------------------------ -- I hereby certify that I ha pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and es d regulations the San Joaqu' ocal Health District. ------------K-----awnerand/or Contract ) (Signed)-------------------------------- -7el4s�, — and o orB / H =- ---�=------------------(Title)-_------ - Y:-----------------------------— ` --- (Plot plan, showing size of lot, location of system in relation tdings, etc., canbe plat an reverse side). 1 FOR DEPARTMENT USE ONLY I ---------- ---------------------------- - ------ DATE. 2 `�6- ---j APl'LKATION ACCEPTED BY---L•..�1��---------- ----- - ----------------------------- REVIEWED - -------- -----------------REVIEWED BY.----------------------- -------------------------------------------- ------------- DATE----- -- ----------------------------------------------- BUILDING PERMIT ISSUED --- --------- TE-------------------------------------------------------- Alterations and/or recommendations: lam ,!�__ - - ---- � -- --------------------------------•------------------- 1` 1..:---•----- �'r l➢ .tr( �c}1 Gc+, 4` t �T.+----- j�-- � nt y --- ----- -- -l.etGL.......... PG±.------� a LI f --- FINAL INSPECTION BY------ --AAN ------------- ----------- ------ Date.----------- , ----- ---------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.