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�. - ..` �CE Q, r v - r o ----------------- 6 r— -- APPLICATION FOR SANITATION PERMIT Permit No. ._If2l� ------------------------ --- --------------------------- (Complete in Duplicate) R� "',This P_err�itE rtx es`1 Yea' Fro Dater ued"""" "Date_.,Issued.,.l Application is hereby made;to£the San Joaquin'Local Health District fora permit to construct and install the work herein described.— This dpplieation,'is-made in c"amplianc�"with,Couhfy`Ordinan�Nc`-549. —•► .,--�.•,.�, a JOB ADDRESS AUD LOC TION_.. I _ ._ �-„ _/uf1_ ----- 31-1 lr ` Owner's Name - - 1 / 1( _ .SStQA_ ----- OAD------------ S` ac f !v._..._..G • Address_____.___-I....__ �} GG//�7 Contractor's Name__ i -------------------- ----------=----- one 1_oi kms_7------ -- ---------------- ------------ ---- Ph Installation dwill serve: (Residence ❑ Apartment House Commercial El Trailer Court [I Motel ❑ Other Number of livin{ unitNu ber of bedrooms _ __ Number of baths ___ Lot size _ Water Supplly:� Public system El Community Community system❑ PrivateA Depth to Water Te ft. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ Adobe' Hardpan ❑ Previous Application Made: (if yes,dote------_____.:_...1 No New Construction: Yes ❑ -No Ik FHA/VA: Yes ❑ Nox., TYPE OF INSTALLATION AND SPECIFICATIONS:,, ,,, (No}septic tank or cesspool permitted if public�sewer'is0available within 200 feet.) -Is. Septic Tank: Distancefrom Hearst well-----------------Distance from foundation_____________ Material---------i'---------------------------------------- _Capacity... ------- ----------- ---------_-------- Capacity______________ ________❑9X1,i Pdfi1 No. of com artments--------------------------Size-------------------------------Liquid depth------ Disposal Field: Distance.from nearest well---_----_--------Distance from foundation--------------I____.D� stance to nearest lot line________._______ ❑�r1Ct,5� P n ength of each line------------------------4 Width of treAch--------------------- ------------ Ty to of filter mat e�ial__________ __ ___}_:_Depth'of filter-material------------__ -_Total length------------: ----------------------00111 -- rr See a e PJ Distance'to nearest well__•eQ.�- - Distance pf�rom foundation ' -p g - -- --- - --__ !� ________.___.Distance to nearest lot line.... Number of pits-----Z-.___._.__Lining material j' /_ 6CX_Size: Diameter---3i3.f r_.___Depth__.. ..___ __ Cesspool: Distance'3;from nearest well_:'______________Distance from foundation._.________________.Lining material•__._.._____._____,_____�_.______.. El . p quid Capacity---------------_1---------gals Privy Distance.from nearest well._._______________- -__________._____________Distance from nearest building - Size: Diameter--- - �-------- ---- '----- --------De Depth --- - --- Liquid I° sf 9 Distancel'to nearest lotaine--- - ------ y Remodeling and/or repai'rin (describe}: --- ----- ------------------- t t - -- = __ ----------- - - ------------- -----------=-------------------------I----------------- --------------' 4. - ---- --..�--- ---------- -------- I her eby wl haveed this application and that the work will be done in a' cco fan'ce with San Joaquin County ordinances; tel! ws, a d rules and regulations -of the San Joaquin Local Heafth District. ` V..� _ ! (Signed) -� --- ---- ----------------- 1 '- Owner and or Contractor ti _ ( � By. ----- -- ---------- ------------- -- ----------------- (Title). = (Plot plan,�showi g stir" ize of lot, location of system i relation to wells, buildings, etc., can be lace on reverse side. p i ;s. ) ,1 FOR DEPARTMENT USE ONLY APPLICATION AC_ CEPTED BY s ? __------ r - - --------------------------------- DATE---- REVIEWED BY .i `-i1�►s' --- ----- --, -- f ------------ ----------- DATE_:• � BUILDING PERMIT ISSUED ----- - --------- -- -= �° i. TE- # 1 DA �. �. Alterations and/or recomrnendations:"' ,� )_{�� -�----- � . - ------------ �- /"' /`- =� ,r [t' - f y ► !r R ct y r 4: -------------------- -.. ..-. -rd +ir . - .�aM6.-r.,�.... _.,. - .. _ - - .... ------------------------------------------------- --------- - ----------- - --------- --------- - -- - = - FINAL INSPECTION BY ________ ____ _ ►^-�- a^-- --�-- .7r _,._..._ Date • li 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 F.P.C .