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r'VKUM-t USE: .mom -------------------=---------------------------- ` ------I------------------- --------- ---------- -------- APPLICATION FOR SANITATION PERMIT Permit No. --- --------------------- ------------------------------- (Complete in Duplicate) ---------I----- -------- ---------------- - -- --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby-made to the San Joaquin Local Health Disfirict far a permit to construct and install 2-f-o herein descri ed. _This application,is,made.in.compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.•( ii Owner's Name____ t 1 ----- ---- - 1- -- - -_�f=--�-' -----'fir--��"------ #-�----- •- �-- -- one Address = � r> /' ------------------------ Contractor's Name------ ' t :a 11 s- ; 'a",-------------------------------------------- -------------- Phone.. F Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel El/� - her-� ----------- -- L [r / Number of living units: "^ __;'Number of bedrooms _ -_ Number of.baths - 'a- � �- . - Lot size ____--- Water Supplyi Public system ❑ Commit s stem ] ,Private p r Y Y ❑ e th to Wafer Table 4� ft. f Character of soil to a depfh,,of 3-feet: Sand ❑ Gravel �andy Loam ❑ Cla Loam •,r y ''Clay [] Adobe❑ Hardpan ❑ Previous rApplication Made: (Ifj ;V TYPE ----------) No New Construction: Yes [-?No [:1FHA/VA: Yes ❑ No TYPE OF'INSTALLATION Ai! D SP' ECEFlCATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet. 1~�4 1 /� A Septic Tank: Distance from nearest well--- from foundation_-_ f , -d_------ Mate ialr ( f �- No. of-compartmen#s_- -----------_Sizef f _ 1C 'AxAid dep#h-- � Capacity ---- .._„ ...i., � �--------------- Dispo..�sall Field: Distance from nearest weli-�K--.---Distance from foundation_-4, ---------Distance to nearest lot line_�Q--�_ I Numbr of lines-1:- 9 _______ r engfh of each line_-_7s�__`__---------Width of french.-A-/_ Type Of filter matrial .. -- Depth of filter material_--_ ''�_.-Total length__ '_-_-__ 1 Seepage Pit: Distarice to nearest ell__.�,O�_�__Distance frgtn fo dation ____ x"490-__-__-Dijitance to nearest lot line-41-0 r �r Number of pits.-, .- ---__.__Lining maf.eriaL_ _.- .Q -Size: Diameter. # r.;< -� P11 Cesspool: Distance from nearest well_________________Distance from foundation---__------------- Lining material------------ ❑ .. Size: ameter---- --------------- -------------- Depth--------------------------------------- -Lquid Capacity---- ------------------gals. Privy: Distance from nearest well__.----------------------------------------- Distance from nearest building --- r• Disfiance'to nearest lot line_______________________ _ Remodeling and/or repairing describe):__._-__---__y.�_ -•------------------••--- ------------------------------------------------------- ----- ----- ---------------------------------- ------------------------------------------------------------------------------------------------------------------- ----------------- -------_------- -------------------•-- - --------------------------------------------------"---------------------------------------------------- ---- ! hereby certify that I Fhave prepared this application and that the work will be done in accordance with San Joaquin Counf 'I ordinances, State laws'and;t s and{reguiations of the San Joaquin Local Health District. y ,(Signed)----------------- -- -- ----` --------- - ----- -- ontract # BY--------------- - -- -- - - n � r or ---- -- {Title}-- f ------------- re (Plot plan. showing siz#of lot, locetio# of syste re anon to wells, buildings, etc., can be placed on reverseide}. or FO DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY... ------ Q------ -- � t t F T a DATE.;- -6-----3at-6 7 REVIEWED�BY ------- ------- ----------- --------------------- DATE -•--- BUILDING PERMIT ISSUED----------------- --------------------------------------- - DATE --- ----------- ------ ---------- ------ :k Alferattons and/or recommendations:-______._..__-_ -kms ---- ------- ----- ------- -------- I ---------- ---•------------ -------------------------------------------------------------------------------------------------- --------------------------------------------- --+ -- i-----• - ---------------------------- ---------------- ---------------------- •----- ---------------= ----- ----------------- --- ----- r FINAL INSPECTION BY: '--A +fes---- ------- --- Date..----------51--16----,.,.,-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ! 300 West Oak Street 124 Sycamore Street 205 West 9rh Street Stockton,California Lodi,California Manteca,"California .� Tracy,California