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FOR OFFICE USE: ------------------_ ______-------------_-------_---------------- APPLICATION FOR SANITATION PERMIT Permit No. _9_1 '%45 ---------------- --- ------------- ---------- (Complete in Duplieete) ------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the r he describ This application.is-made in.:compliance,with County Ordinance No. S lQ76 1mS_ JOB ADDRESS D LOCATION____ - - 07"-- - �.._ � Owner's Nam - W Address --- - ---r�� --• -- -- -��--�•—�,o--�--•�-- -- �.----- �-cam..,. Contractor's Name_ --'4-- -- \ .. ..... --1--/ --1----- —U -_t.. *-------------------- Phone n-:i f // i Installation will serve: Residence A/ artment bio I ❑ p se ❑ Commercial ❑ Trailer Court ❑�. Motel ❑ Other Number of living units: ________ Number of bedrooms _______ Number of s -----__ Lot size __f Water Supply: Public system El Community system E] Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Ciay Loam ❑ Clay ❑ Adobe0--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No + FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �yV�_ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel_ P �- Dist`�c om�� _.Mate ' - --- --------------- �---- -----� No, of compartments_ ----------__--Size,J � Liquid depiFh_�e ...Capacity Ca acit �-Ve ` ,} P Y cal 'f- Disposal Field: Distance from nearest well __._.Distance from fa ndation_,��. �__.Distanca to nearest lot line Number of lines__ Length of each Ine �' f --- � Width of trench------- 4 Type of filter matye Depth of filter to Total length_________________ ._ _0 «Seep❑age Pithbee f nts restwelL- '.Linin material Distance from fo nds ZionD:- _____ ____.Distance tone rest lot line_.____-__.____._ P - g e 4 jameter-----------------------Depth---- --------- Cess wol: Distance from nearest well-----------------Distance from founda+ion___-__-__.___._._ Lining material--------------------------_------- _,, . Privy: .D.?`tante fromra�eares tom' --Depth --------- C ----Liquid apacitY----------------------------gals, I ' f`well_------ ----- :.•-5--------------[ Di0ance from earest building------------------------------ r w Distance tonearest10? Imes ` --------------- -� ------------------------------------------------------------- Remodeling d/off repairing"'(describe):--------- ' -- -' 1��, ,® Q ---- - -. a ---- ---- ----------------- 7K v ------------ -0--- 9-------- I herebyc f = '' certify t�have prepared is application and that the work will 6e done in accordance with San Joaquin County. ordinances, State laws rules and regulations of the San Joaquin Local Health District. 0 Mc' rli b (Signed)______ _WN '� _____ r ontractor) 13y:2915 ;t�lierAVe:,- NO_-E-3841 ----------------------- --------I---- F-1 ----• --- --- r (Plot plan, showing size of lot, location of system in relation to a buildings, et .,can be placed on reverse side). _ FOR DEPAR MENT USE ONLY 01 APPLICATION ACCEPTED BY------ .- -._ "� +� ` REVIEWED BY --- --- _ =--�.a - ------------------------------------- rDAE_- �--,~: 0,0;511 --------------------------------------------------- ------- -------�- ------------- - -- ------------ ------------------------- ---- DATE------------- ------------------------------------------ BlilLDING PERMIT ISSUED—" f D - E.----- Alterations and/or�srecommendations:= ,._ .� (� c ,Z , � __�yy _ A 2L.�Ct!4. C f'lxt --- --- -- -- -- -- ' ---- - --------- - - - -- �- ------ I ---- -- ��_ - ---- --� ----------------- - _.------- ----- ---------- - - - -------------------------------------------------------------------------------------------------- -- FINAL INSPECTION BY:_..... ---------------------•- -- ---------- Date_... 4 ,f ' r+•ilk... �`f, SAN JOAQUIN LOCAL HEALTH DISTRICT t 1401 E.Haselton Ave. 300 West Oak Street r 124 Sycamore Street 205 West 91h Street I ,CaliforniaM Stockton,California Lodi,California MantecaTracy, California t