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FOR OF CE.USE:--` - `.fir' '------------------ --------------------- -- --'�`.awe -------- ------------- _ APPLICATION FOR SANITATION PERIv�IT , - 4 Permit No. ------------------- (Complete-in Duplicate) J _ Date issued ------ --- -------- -- --- -- _-- This Permit Expires 1 Year From Date Issued '? Application is hereby made to the San Joaquin Local Health District for a permit to o struct and install the work herein-described. This application is made in compliance with County Ordinance No. 549. "*-�: { JOB ADDRESS AND LOCATION--------5QUthers1.__,Paaif.is___Cla.-__Fre_ight---lar'ds_,___off--Calif'..__&_.NicK Kin Owner's Name--- 0�1f 7GZ'Il -Pa f 1C-- 0--------------------•--------- ---- ------ --- --------------- -----------.. Phone---465--.8225---------- AddresW__East- Channel__.S_t_s_�_..St0Ckton ----------- ---------------------- Contractor's Name--by--- --•------------------------:------- - -- ------------------------------ --- --------------- Phone------ -------------------••-----.. Installation will serve: Residence ❑ Apartment House ❑ Commercial JE] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ----- Number of bedrooms _.. ---- Number of baths-------- Lot size ----- __ ________ ________ ____________________.__....--. i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [3 Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date_.__ -------- } Nod] New Construction. Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS:' ..�. e (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellgVarl501s#ante from foundation---20...,f_t,Matarial ---a.Oncre-fie---------------------- No. of compartments_____.._.. ---------------Siz �. 11 tt Liquid de th....._�, 11 " �� b3: = 6� q P. ---`-- --....CapacitY-2 d . Disposal Field: Distance from nearest weilpy,,ar1501stance from foundation---.._2-Q__,ftDistance to nearest lot line----5.t_____ 4 Number of lines -------------4------ ----._Length of each line__ -55. 1-----.-_.-----_---Width of trench_.2}j_sr------•--------------- T ------------ .. Type of filter material_WASh___r.ackepth of filter material__�3-6_' `"3_TofaI length---2-20t!__________________________ over. 1 Seepage Pit: Distance to nearest well_ ...... from foundation_.2Q........... Distance to nearest lot iine_5.t........ Number of pits___--- Lining maferial:!!--- ........ Size: ---------Depth------2- t------------ I ------ a Cesspool: Distance from nearest well ________________Distance from foundation----------:'____ _ Lining maferial_.__......_.____--.____._._-________- ( { ❑' Size: Diameter- -- -------- ----- ----------------Depth----------------------------- --- --- ------Liquid CapacitY gals. I Priv Distance from nearest well_______________________ f Privy:, „ --------- -- --- ---- -Distance from nearest building------------------------------------------ ! 1 ❑ Distance to nearest lot line - - -'-------------------------=---------------------------------------------- ------ x _ Remodeling and/a' r repairing (describe):_;:.Xear__.install.&tion---------- = � fey ` ----------------------------- --- -------------------------------------------------------------------------------- -------------------------------------- ----------- ' ----------�----------- ------ --------------- --•---- ------.. ----------- ---------- --- ----------------- --------------------------------------- ----------_ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San 'Joaquin Cou'ntyj-- F. ordinances, Sta`te�laws, and rules and regulations of the San Joaquin Local Health District, s y ` (Signed)-•- 50 7e 's� _G...�iQ.......................- - - - -- - ----------------- --_--------------- `---- - ------(Owner and/or Contracto..,,,� SY:------------ f r=-�'Q'Q ': - (Title}: W&F 1$p e r' vis-or (Plot plan, showing size of lot; location.-of system in relation to wells, buildings, etc., can be placed_ori reverse side). FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY-------------- ------ T :_•______ pATE --------- 7 -.x REVIEWED BY...- --- -------- -'-- DATE--- BUILDING PERMIT ISSUED------ ------------------------------------------------------------------ ....... --------- DATE------ ------------- Alterations and/or recommendaty'7]ions:- --- --- -- --------------- ------------ ------------ ------i-�--�ti - ----------- •----•*- --------••------------_' .r -PP y '7_�/ -' # �r1 �----- uc. � �-- £ s 1 ---IGS -�"=►'------ -- ------- -- -- --t- �- - ----- -�-� ” ---- - ---• � -- --- ,� !�• 4, � Y C7 fi�g{{ �1 ✓� f, ).ed-&A--- qz: "r I ►.I rhe { &7 :1'�3j4• r d ` FINAL I SPECTION BY:---------- ------ --------------- -- Date- t m S JOAQUIN LOCAL HEAL RICT 161 E.Hazelton if 4 lCvi. / /u 300 est 6bk Street t/'` camore Street 'i 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press