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- -------------•---- ------ - r y __..__.__._..__.................. _ __.. A _ICATION FOR SANITATION PERI Permit No._2.1_.__1��4.- _.... --------------------_----------- - (Complefe•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, JOB ADDRESS AND$770-CK-7-0-1\1 LOCATION__ 4 9__W_(\/G----W V- ---------- ------.f a-F a -----S.l 4 E ------------•------------ Owner's Name T .. t �lY.- - `=-•--` 4.,...... -�i _ Phone Contractors Name----- --------- ��y f__. ._ _. x '.. Address---•-•-••-----•-- �-•--------��---�----�!'_k!_.. ..-•-•-----=-� ....---�_�.a� 5-------••------ ------------ ----- ------ Phone_'&L &1,-.,/----.- Installation will serve: Residence ❑ Apartment House ❑ Commercial W Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __.._ Number of bedrooms -------- Number of baths ---- Lot size ---A GE/I�C" Water Supply: Public system ( Community system ❑ Private, Depth to Water Table 70._ _ ft Character of soil to a depth of 3 feet Sand E] Gravel ❑ Sandyam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date-- _ ---- ---- ) No ❑ New Cor struction: Yes [A No ❑ FHA/VA: Yes ❑ No Pg TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Qistance from nearest weIIJAJ6 VC__Distance from foundation_f.O---....__..Material -�______________ _ ® No. of compartments-InV-0........ ._Size-4.K---il .....------Liquid depth._SZ__.--- --------Capacity.6Qorn(Si . E�� Disposal Field: Distance from nearest wellNPA)C_Distance from fc�gdation__Aa..........Distance to nearest lot Iine...r�'_'__......... �j Number of lines ._._ . ._-----Len th of each In �QG'__� .1.f___._..Width of trench.- • .p_-r.................. T 9 Q Type of filter material._I ;?`~ ...-------Depth of filter material__1.. ------------Total length------Ira_-1.0...................... i � Seepage Pit: Distance to nearest wellAk/��_..__Distance from 4u6dation...60.. ......Distance to nearest_lot li�e_.S.__.__.__ bI Number of pits. - ....__.Lining material.... — Size: Diameter---3_$.._. p Cesspool: Distance from nearest well ................Distance from foundation----------------- ..Lining material..................................... ❑ Size: Diameter- -- ------------- ----------_..._.Depth...-•----------- ...................................Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__-•_.-__•_.•_.___•___-__________-__..... ❑ Distance to nearest lot line -----------------------•--------- •--------•--------------------_- Remodeling and/or repairing (describe):--- �_($.t4AJ. - .3 - -----_-C_Pjr& r1-.r."_______________ ---•-----••-----•-•-----------•----------------- ---- ' A-P-.".91 t-�xC -:------- ............ - j U...................--------------------------------------------------------- .............................. ----- ---................................I-----------=----r...-............................................................................................................................................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfoe--Iaw5;"Md-rules andregulationsof the San Joaquin Local Health District. (Signed)..................... _._ ... _P_ _ _ _ .._._(Owner end/or Contractor) Y:-------------- Title ----- ..(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placedbn�`rreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -- ------ ----------------------------••-•- - REVIEWEDBY------------- ---------------- .........._............................................................................. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED.------.-•-•••-•••-••--••------------ ----------------•-----...................................... DATE............................................................. Alterations and/or recommendations:...................... ........ --------............-------------•------...-•-•---••--•----------............................................................. ................................ -- -- ------------------. --......---..._.......•••-•-•--••.....--•-•..........••--••---•-•• .................-----•-----•---•-•-•-••------••-•----•----.....••-----•--.....-•-.....•--•- .....................................y................................-.........•••-•--••--••-•••-•-•--••---•••--•••-••--------------------•••-•••••-•--•-•--••-••••----••---••-........----••-••-••-----•._..............•. ..............._..••--••-•.......................••----•.....-................-....................... ........................-•.............-------•--••-•-.._.................................. FINAL INSPECTION BY• ��`'L .s±^ Date.J.-.Z�_4�Z7................... SAN 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 E.H.9 2M 1-67 Vanguard Press r