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FOR OFFICE USE: - la f ---------- ------------------ --------------- _ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- - --------- ., (Complete in Duplicate) ...._ G----- r =- - =:V Thigs Permit Expires 1RYearr From bate Issued ""- '"` bete Issued i ation-is hereb- ; pp y de to the San Jos uin Local Health District for,'permit to construct and install the work herein described. This application is mace in compliance with County Ordinance No. 549. JOB ADDRESS A D LOCATION — � / i�.0� � Owner's Name--4 _ _A__4- -f-.------_. - i Pho I u ----------------------------------------- Address -----------------n----------• -- l Address--•--------•--------•---�-�- �--�•-----�---•-- --- -- - ----- -• -•------Contractor's Name H------------------�N� r/VC • -----------•------------- Phone_-.----•---•------ f Installation will serve: Residence A Apartment House [3 Commercial ❑ Trailer Coi urt E] Motel [:] Other El' } _� Number of living units: _�_____ Number of bedrooms __ Number of baths __1___ Lot size _7 i -,/ S _-_-_--_ ..� Water Supply: Public''system �` Community system []~ Private ❑ Depth to Water Table(g-Q ft. Character of soil to a depth of 3 feet: )Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑` Adobe Hardpan ❑ Previous Application Made: {If yes,date____ _ __] No IM New Cons#ruction: Yes k No FHA VA: Yes a ❑ ❑ . No fi TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank�or cesspool permitted if public sewer.is'availeble,within 200 feet.) Septic Tank: Distance from nearest well_/-�lWW'Distance from foundation__/a�� Materia No. of com artments_-. _.T"�`,--- p Size= ::K= �'"'----- ---L� uid de th--- --------- .--Ca acit - P Y-/-Z�JD.�1 P. Disposal Field: Distance from nearest well ' � d AkV_�D stance from foundation___ ! __=- ._..Distance to nearest lot line__`Q-----__- r [ Number of lines....4:9 3 L,�- Len th of'each line----- _�/ _- - :��`,--_-Width of trench.-2.4!' ------------- a-»:g Type of filter material_ - Depth of filter material___-__ ��.r---- Total length----loa-'------------------- See age,Pit:. Distance-to,nearest-well-1019W.�tDistance f oM."tion_ p - - �_-_-_.Distance to nearest lot line___1Q____ Number of pits_-_ _''L'ining material___j'1i« zDit � p ' " .5`--------------------- Cesspool- -------------------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----- ---------------------__--- -- --- 1 ❑ Distance to nearest iot line------------------------------------------- ` - ---------- -------------------- Remcdeiing and/or:.repairing (describe):__- -- - ----- - ---,-- --- --------- -- --- -- --- --------------- ---•---- - - :cr-------•---- _ r -- ---------------------- r -- _____ _________------ __-_---_--_---_______--_____ __ ____.__. k � _ _ _ c --------------------- ------------------------------- ------- __ _----------_____________________.___-_____________-_.__-___________________----____..-.________-_- t� 1 `relay certify that I have prepared this application and that th work will be done in accordance with San Joaquin County ordinances, State la nd rules and regulations=of-.the San Joaquin Local Health District: (5i ned g )--------------------- - - ----- _: �. F .- -- -�{----�-�/V - ---- --------------`------------------ Owner and/or Contractor) By:------------------ i--- - ----- -- Ti#le 9 ) *- (Plot plan, showing size of lot location of system in rely ion to wells, buildin s, etc.; can 6e placed reverse side). t I I a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY oee------------------- - ----------------- ------ ----------------- ------------ DA TE__ REVIEWED`�BY_ 6_ - 1 - - -•--------------- ------------------------ ATE---------- - ---------------------•----------••--••------- + 'BUILDING PERMIT ISSUED = - ---------------------------- --------- DATE - Alterati s rid/or recommendations:_-____-. . _ _ ---, _ i = ------------- -- ----------- I =� ---- ---- ------ /(I � t - - --- - �:.3' --------- t6/��( ��itr -c ��J p"`-�l.t.�`Jte. �� ,�:�,a�3 cy-- ---- �- , IN L INSPECTION BY:...___ - --------------------------------------- Date. ------- SAN -----SAN JOAQUIN LOCAL HEALTH DISTRICT / 1401 E.Hazelton Ave, ri 300 west Oak Street 124 Sycamore Street ZOS Wes!9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C13.