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FOR OFFICE USE: ` -------------------- 11 II /s ,. APPLICATION FOR SANITATION PERMIT Permit No. ..liF- 6 --------- ------------------------------ I-------------- (Complete in Duplicate) �j� r- This Permit Expires 1 Year From Date Issued Date ,Issued --------------------------- -- ----------------------- 1 o 9y—, e23 o-mss 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 LOCATION-A. t -- Owner's-Name---------�_��_�.4�_�'�_�'.��-"z-�.�--------�p�_f/V--- ----------------- --=------;- - Phone.---.,------------------------------ i Address-----------------�- e 30X-----j ��----- -' °°t7"d-�--------------------------- --------------------------------------------------- Contractor's Name--- ) ZA -,. Phone � s Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑II Other El_ - t Number of living units: - -- Number of bedrooms _ .. Number of baths -__7. Lot size ----- ..�-.G-AW------------------- Water Supply: Public system ❑ Community system ❑ Private Dj Depth to Water Table ._____._ ft. III Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ®L Clay ❑ Adobe ❑ Hardpan ❑ �- Previous Application Made: (If yes,date---------------------) No New Construction: Yes ❑ No ®. FHA/VA: Yes ❑ No ER TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material------------------------------------------------- : ❑ No. of compartments---------- ---------------size--------------------------------Liquid depth---- r-------- ----------C Dis osalId` Distance nearest Distance rati � Distance to IM-a-st lot_line---,!5' amNumbeof IneSl - Length of each lire _ :Widthoftreneh.. p ,r----- --- ._._.._.._____-.._-_- .Type of filter material------ 4___Depth of filter.material---A$_----------Total legth i Seepage Pit:` / Distance to nearest well--- Distance f� foundation__,�1� _ oc"nS -_____ -Distae to nearest lot line--�G`�..._. Number of pits______-�-.___._._._Lining material-_ �- , Size: Diameter_ _____ Deph_12- 7_1 ....- '`______________ Cesspool: Distance from nearest wek[-----------------Distance from foundation.........-.-- -- Lining material1`tl-.--_._--------__._----.-----_-_- --------------------De th-;---------------------------------- -----=---------Li Liquid Capacity-------------------------- als. ❑ Size: Diameter-_- p q p y- 9 .--/ Distance from nearest building �� Privy: Distance from nearest well-- ----- --------------------------- --- - g----- --------------------------------- ❑ Distance to nearest lot line--------------------------------------------- ------------------ ------------------------ ------- ----------------------------------- Remodeling and/or repairing (describe):.-.--__ ------ "f .._._•- -/hS__ ./. _ '-___- 14� / .( ------------- ---------------•-------•--------------------------------------•------------------------------------------------------•----- ------------------------------------------- --------------------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------•-- ------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--I------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance 'With l San Joaquin County . ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- A ---1 S.141 r-----Z� YV -------- -------------------------------------------------------------------------Ow Or and/or Contractor) ) i 4(ion -------- -- ------ ---------------------------------------- {Title) ------- -----------------------.-....(Plot plan, showing size of lot, of system to relation to wells, buildings, etc., can be placed on revers side). OR DEPARTMENT USE ONLY / -- ------------------ DATE-----------APPLICATION ACCEPTED BY REVIEWED j BY---------------------------------- -- --- --------------------- ------------------ ---------------------------------------- DATE---.-----•--------- =� BUILDING PERMIT ISSUED------------------------------------------------ ---�;� ------- -------------- ------------------ DATE---------- - ----- - - � -- Alterations and/or recommendations:_--��_'7_'_ _ _.......___-f_�1 ___ ______ �1-."-..---- M-- ,r�--.c,- ----=- - - ----------------------------------------------------------------------------------------------------- -- ---Il------------------------------------ -------- ----------------------------------- - ------- ------------------------------------------------------------------- - ---------------------------------------------------------------------------------------- - I ------------------------------ -------------------------------- --------- ----------------------------------- ---------------------------------- -----------------I---------------------- --------------------------------- I VV ------------- el / FINAL INSPECTION BY:- .l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California 7 lacy,California f