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FOR OFFICE c —20 703 /,-,3 -0 --------------------------------------------- ---------- -- --------------- ----------------- .;.__,___--____ APPLICATION FOR SANITATION_PERMIT Permit No. .. _ �a --------='--- --------------- - ------------------------ (Complete in Duplicate) --------------- -- 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;work herein described. This_appfication,.is,.m ide_in-compliance with County Ordinance No. 549. 205'-_3 -6::b c� T JOB ADDRESS AND LOCATION--1 --- -`---•----- I��JBF—:R_L- ----------3_RT-_--- RA I�'�1� --------• FA -T_ Owner's Name_____________________ Ph ``II _ ------ Address --._. Phone----------------------------- - Address---------- T-. — Q.S_ t _LT 07f69 --- ---- --- --------------- Contractor's Name_____ aPTr _ 1 C --------------------- Phone----------------------- on willrve: Installa ie living i Residence M"--Apartment House Co�rnercial E] Trailer Court ❑ Motel Other E]tuber { Number of bedrooms _ ._ Number of baths -!;?-- Lot size r --------- ---------`---I Water Supply: Public.system ❑ Community system ❑ Private [Depth to Water Table _ _ ft. Character of soil to adepth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___________ ________ No)' `1 New Construction: Yes [�No ❑ FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic`tank or cesspool permitted if public sewer is available within 200 feet.) tic Sepnk: Distance from nearest well___,_0_r._Dis#ance from foundation-__M-)---------Mat9riaL___CQNC.-_R- TIt=----_-- INo. of compartments------2--------- _ Size_- k-c�-k—_.Liquid depth_ -Capacity...fZ�O-_. Disposal Field: "Distance from nearest well'5;FDirtance from foundation�_}____1 = _. Distance to nearest lot ling___ Number of lines----=-------------------- '—___._'_Length of each line----- [Q�-_ X-----Width of trench------- - *� ..- p a r 1 14 Type of filter material___ QC �,----De th of filter material--_' _ __...___--.To#al --------------1',Z ----------- Number of its.-°______.________--Linin ' Seepage Pit:.,. Distance to nearest well_._._____- __:.Distance from foundation------________-----_Distance to nearest lot line__.._._____---___ ❑ P gmraterial Size: [}iameter. Depth_ Cesspool: t Distance from nearest well-----------------Distance from foundation....... __-Lining material-- r Size: Diameter--------------------------- ') _... ❑ Depth - - ' ------ ---------- ----- -------Liquid Capacity - -----•-gals. ..1 rrn��r=r+rr��caas.w.r r��wr�+...+•:. � .�- -. Privy: t Distance from nearest well ___ ----------------- __ ____ Distance from nearest building __--:'---------------------- El '-____--.-_-__---_ ❑ I Distance to nearest lot line ---------------------------- --- . ' ! _____________________ --_____.__-____. --------- Remodeling and/or repairing (describe}__________________ INA v$-no 3 . ---------------------------------------------- ---•-------------------------------------------------------- 1- " =ALF.A_ 11,-,4&1 1 - -------------- --------------------------------------------------------- I 1 I hereby certify that I have rep red this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ' 2_1 nd rul s an regulati s of the San Joaquin Local Health District. l (Signed •' ---------------------------- -----------J (Owner and/or Contractor) t By: = '------------- ----------T-kRA _..----------(Title)-----------'=--=' ------------- ---- .._...--- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). # l; FOR DEPARTMENT USE ONLY j: i APPLICATION ACCEPTED BY "-------- ---------------------------------------------------------- DATE---------- REVIEWEDBY----------------------------------------------------------------------- ---- DATE BUILDING PERMIT ISSUED - - d_---------------------------- DATE. Alterations and/or recommendations----------- -----------------------' - ' - - -•------------------------------------ ------------------------------ . : hitt..� ------------ ----------- ------- --- -- .... - -------------------------------------------------- ---------------- -- --------------------------------- --------------------------------L " ' ' --- ---- - --•---------------------------------------------------- --------------------------------- --------------------- FINAL INSPECTI . ..._. ±' Date - ' SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Trac c, - y,California F.RCO. ' k