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FOR OFFICE USE: _ I------------------------------ ----- APPLICATIOhI .FO$ SANITATION PERMIT V Permit No. ._ �_ .��✓ , ! (Complete-in Duplicate) ----- ---------------- This-;,Permit Expires f Year From Date Issued " Date Issued le ti. 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 Coun4y`br8inance No. 549. q JOB ADDRESS AND._LOCATION a�_,30-- r� _�i9C , A!<_ _�----------------------R.)_T' _ • Owner's Namo_ ;;------- ---- - ------------------------------------- Phone------------------------------------ Address------------------- 3 L1py #{TMW - RD i�1 raa _ .... Contractor's Name---.ANTHQ1V Y--_a-_!5.0-- ------•-------------- - Phone----- ----------------------------- Installation =Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ y Number of living units: J..___ Number of bedrooms 3..._.. Number of baths-2L—Lot size ---14:CR.EA6i�;77________ € Water Supply: Public system ❑ Community system ❑ Private [21bepth to Water Table/�ft . Character of soil to a depth ofi3 feet-,, Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If-yes; -TN-6 New Construction: Yes ❑ No FHA/VA: Yes [rff-1-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _.,.W' ""'� ��""'"'' • No'`si:tic tank or cess-oal -ermiftedrif"ublic�sewer is`availa6le within'200'#eet:J- �;�`�- --'�°'- --�•�-�--�r p p`� P . p � --- lom foundation_/6------ ,.Mater-, 1� 'p1\VC_RJ _T" ---_------. 4 Septic T k: Distance from nearest well___:��.-__Distance from No. of compartments____ ..."S'iie__ D_X : Liquid depfh`.__y1/'�L--------Capacity---1247C.... • i Disposal Feld Distance from nearest wellQ Distance from foundat __.____..:..Distance to nearest lot line.___ p� Number of Imes__ Y 2-------- Length. o�h line_ _ �� ;�------�Wid#h of trench.-- --�-�_. .-------<------ ,� �'+ p i i'er material_._./7---------. Total lengths_ .--`—_—_ --- --••---- `'� Type of fuer materia} - _---:Del, o$rfi} Seepage Pit: Distance to nearest well. Distance from foundation___-_._--.___,Z'_._Distance tonearest lot ling!_.____.._____.._ ❑ Number of pits--- ------------------Lining material-------- __._.-_------Size: Diameter------------_......_--Depth ---------------- Cesspool: Cesspool:. Distance from nearest well----------------- _Distance from foundation__.._ ----- ..Lining material--------------------i_____,_______.. ❑ Size: Diameter_ __ --------- D1. epth.............. 1------------------- �----- Liquid Capa4 city _' . ..gals. Privy Distance from nearest wll-------------------- e ___________._......___. Dance f—romi ,_ T nearest, ____ ________ ___,_________r_ _ ____ i ❑ Distance to nearest lot line _-_.___...._- Remodelingt(building,! be -- ry - -------------- I re airm and/or A g (descry - ------------ ---------------------------- --------------------------J-------------•----------------------------...-----•------ y:r - ---------------------------------- — �`' --- - -.--------- I hereby certify that 1 have prepared t�_is application and that the_work will.be-done-tn-accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �• { t (Signed)------ ------ ---.�- ----- --- ......... -�. ` cps' ,. ------------------------ (Owner a Contract •`--�- ... wne nd�o r)i (Plot plan, showing size of lot, lora+ionystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I r APPLICATION ACCEPTED D BY r. .. - ------ ------------------------------------------------ DATE------ REVIEWEDBY ------ ---------------------------.- ----------------------'------------------ ---- DATE ' BUILDING PERMIT ISSUED-------- -- ---------------------------------------------------...................... ........-.----- DATE----.----------------- Alterations and/or recommendations:--------------------------.....-------------------------------- --------------------------------------------- �4 r v '� ----------- ---- - -- ------ ---- ---- ------- = ---------- -----------•------------ - ... FINAL W SPECTI - Date �� - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:eltan Ave. { 300 West Oak Street, '? 4 124 Sycamore Street 20,5 West 9th Street Stockton,California Lodi, Cafifornin Manteca,Carifornia �` Tracy,California E.H.9 2M 1-67 Vanguard Press 4