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........ ••• •••. ..----•. ._. ._. ....... APPLICATION FOR SANITATION PERMIT Permit No. ........ •_. (Complete in Duplicate) �- •- •_... This Permii Expires I Year From Date Issued 2 ------- -------- -------- Date Issued ......... Application is hereby made to the San Joaquin Local Health District fora permit to This application is made in compliance//with County Ordinance No. 549, P dam- construct and i all the work herein described. JOB ADDRESS AND St�ATION.._.4JE — �� FS�14�Q� P1�-_.. . V- ---. .2. � _..1�� /- H_R.c7_�-_L� Owner's Name.,....... o_j c A�5 pf�f 7 ice? Address............... ,7 e.......-........................... Contractor's Name......Qyv-N_t=R ....................................... ---- --------- -- ...... = .......... Phone...... _...._._......._..__._._..._. Installation will serve: Residence (Apartment House, Comrrlercial ❑ Trailer Court t ❑ Motel ❑ Other ❑ Number of living units: .1.... Number of bedrooms"N mb&r ofzbath S ___ Lot size __.. Water Supply: P156iic system • �� _.J.19 Water y ❑ Community system ❑ Private epth to Water Table .�?. ; ft. Character of soil to a depth of 3 feet: Sand 2r-`G' ravel 0 Sandy oam Clay Loam Clay �,�/ Sandy ❑ Y ❑ y ❑ Adobe❑ Hardpan U Previous Application Made:. {If yes,date........... ..___._.) No�IVew Construction; Yes zz_TY.PE,0I;ANSTAL_LATION_AND;SPECIFICATIONS: �N° ❑ FHA/VA: Yes ''No ❑ —(No-septic tank or cesspo-I' errmitted if-public sewer'is available within 200 feet,)= Septic T k: Distance.efrom nearest well....5 .....Distant from foundation.... �99.._...._.Materiel_.. CR. T ,._.. .. No. of co p rtments__....'2.._...._...Size.-XA/0.X�Li Liquid de fh_... .. � 9 P ��..._. _._Capacity..l z0-�J•_ Disposal Field: Distance from nearest well-., (� Distance from foundation.._.1 .__._-_..Qistance to nearest lot line.___. ►' r .. Number of lines..... ----------------- Length of each line........ .._. Width of trencfi.___..__.�'l_ ..._- Type of filter material- �.. •••• ••••. Depth of filter material__._./ ........Total length.._-_- _._.._ ............... Seepage �t: Distance to nearedfwelL-___25- -----Distance from foundation.... 5 > ..•..Qis+ante t nearest lot line............... Number of pit s' Lining material...s S"?. fS-.Siztc.-�,Diameter-, 'p� iDe th........ ................ Cesspool: Distance fF m nearest well.___.... .\...Distance ❑ Size: Magi'eter...... ........................-,Depth...... X apaci ........ e ........ ---- -.._Liquid Capacity _.. ...............gals. Privy: Dlst `c'e from nearest well... .......... ............ . ____..Distance from nearest buildin T ❑ Distance fo nearest lot line.................... .... Remodeling and/b, repairing (descrvbe):............. ..... -- ............-- - - - .................................................... .-----. ... ..------._......__...------•--... :::: ..........................Y.__....._.. ..._. I ._...... .-_-------- • I - .............. ....................................---------- ---------- . ,. _. . ..... ........ . . ...... . . -•-- . 'tl i+i l.................( IvA� J 1 I I hereby certify that ) have prepared this application and that the work will be done.in accordance withs San Joaquin County ordinances, State laws, at d rulesand regulations of the Sari Joaquin Local Health Districf. (Signed) /•'-'f�r!/ . _....... "By:__t. .___ _ _ r Contractor : .... -----•...:.......... =—= _ -'"'-'- ted/o t ontr (Plot plan, showing size ofr lot location of,system in relation to wells, buildings, etc., can be placed on reverse fide). -� _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTElf BY. ... '_Jb - _ ___..... ... DATE----..... d�� 2 —�_S REVIEWED BY.... ------------- .M----•-... ....f.. N . .......... .._... •--•---- DATE..'_).:.. f � ....... BUILDING PERMIT ISSUED-----....... _...... ►, �. t►.......-- 0 ..----- . Alterations and/or recommendations:__-_- , - ... .... D -. ----- --- -•--------- z z� ,� ao .... __.. ._.. .....------• ------.._. .................:. .......- ----•• ate. .... ............. ......... •... FINAL 1NSPEC71S2BY:. 4 V._ .. ? � - --- ----...- Date...------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street _ • _ 124 Sycamore Street 205 West 91t,Street Stockton,California Lodi,California Manteca,California •Tracy,California 01 1 •� LJc+{.