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FOR OFFICE US : -- _._.!o_ APPLICATION FOR SANITATION PERMIT Permit No. _.!�. �E_.___.. (Complete in,Duplicate) ------------ This Permit ExjRires i Year From Date Issued Date Issued --------- Application _ 'rl..__.'__ ___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. , r� JOB ADDRESS AND LOCATION---- �° Ware-R Loa �°--`-•-!+-.. „ ` Owner's Name----- - le_3-A s--_---- �n^ _k ---------•--------------------------- ------------- -- ----------------------- Phone-14-0-- ..•�_---•---- Address-----------------------�_S�m E_�--•_. Contractor's Name----- -=---_.. ------- -••SD-!1____----- 0.1e Phone...}706.4 607----- Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___t___ Number of bedrooms _2...Number of baths _!_-_- Lot size ------------------ C_ �=k1Gl_-__________-_---- r Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table .10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (9 Hardpan ❑ Previous Application Made: (If yes,date----------------....) No § New Construction: Yes IBJ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well__/_/.x1--------Distance from foundation__.1.¢-`_.______-Material__._44ONf��rE r - - ------------- ® No. of compartments-------_____--------------Size_,_'_ —___'X__8-----___Liquid depth:_____--,-_ � Capacity__��_9144- Disposal 14 - Disposal Field: Distance from nearest well--��:`---.Distance from foundation------e�Q_'__._-Distance to nearest lot line---- _r__--_- Number of lines------------I---------------------Length of each line__________ ---------Width of trench------------;2-54_v______.-- r Type.of.filfer material 2D.9-C�-------Dept h.of„filter;materiaL_____1,e_`------Total length_____________________ -- ------ � � Seepage Pit: Distance to nearest well-'--/049............Distance from foundation------/P-___..Distance to nearest ]of line____ .�.__.._ Number of pits-------- Lining material__� Size 'Diameter-------33 ''�Depth------------A_ -- -----• 6 Cesspool: Distance from nearest well--------------.._Distance from foundation''.'___ ------.Lining material____________________________________. ❑ Size: Diameter--------------------------------------Depth-------------------------------------s-------------Liquid Capacity----------------------------gals. Privy: Distance from nearest.well--------------------- --------------------------Distance.from .nearest building------------------------------------------ ❑ Distance fo nearest lot line__ f a. ------------------------------------------------------------------------------------------------------------ to Remodelin and/or re a4r n (describe):_____ _ - ST►4LL----- ---------------------- V �~* Remodeling / I p 9 �N - me k ------------------•----=------------k-- # p ------------ --------------------------------------------------------- -------------------------------------------------------------------------------------------- -----------------------------------------------•------ --------------- •-------------------------------------------------------- ..._______•______________________________________________________•___•_ _________-_____________________-•___-________________._______._____...____ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I"', and rules and -regulations of the San Joaquin'Locall�,Health District. (Signed) --- - - ------- ---------- ------ - `' -- -- - ----------------------(0 ner and/or Contractor) t By:------------- - - f - {Title)---------- c9 - ----------------------- --••------ (Plot plan, showing size of lot, location of syst m in relation to wells, buildings,.etc., can,be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ 41 ------ �•``---------------- €--------------------- DATE---- ! �'r= - ----------- REVIEWEDBY -------`-`---------------------------------- -- ------------=--------------- ------------ DATE ' BUILDING PERMIT ISSUED~'_':----------------------------------------= - .-s. I DATE------------------*------ _ n _ Alterations and/or recommendations:-- --___�� r � ---------------� ,Imo ` -- _• ----r =' i p f -------------------------------------•------- ----------------------------------------------------------- ---------------- r ------------------------------------------------------------------------ -------------------- FINAL INSPECTION BY:-- /(.�... C 'r-�ti_------- ----- Date.--/;,",)—. ------ „, ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEa 13-59 3M 3-•63 F.FX0.