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FOR OFFICE USE: - -� ----------------- - ---------------------------- -------- ----------- ----- ----------- .9' ________________ APPLICATION FOR SANITATION PERMIT Permit No. . ..... ----I----------------------- ------------ {Complete in Duplicate) d ._ _k. c:jNE''7a.�:a4r� - Date issued . -,1-_-�b - .:: -- This Permit Ex Tres, t Year From Date issued Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made comp' nce with County Ordinance No. 549. �Z R ©� V 5- 5 JOB ADDRESS,AND LOCA'�10:N5----4011JE�TR_ E-------- T4�,'ll(----- %�CTQN_--- ------ JV/ / l Owner's Name---------i r p�1 oR-l_61----•---V14)--- ._VLJ ------S ON S' Phone--------------- ---- ------•--- Address-----------------jB_.TE--`-1 13® ESCA h Ct/V ---- ---• -- --•--- i Contractor's Name_OL_CASg5PTf --s_E}Q1 --- ------ Phone---------------------------------- Installation will serve: Residence Pr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _r.2-____ Number of bedrooms Number of baths _p-_�____ Lot size __.:?� _ ____�� - -_----_---- Water Supply: Public system ❑ Community system K' Private ❑ Depth to Wafer Table 3.57ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: lif yes,date.______--.------ ---1 No K_ New Construction: Yes ZNo ❑ FHA/VA: Yes ❑ No Fr— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tariFor"cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__S10_____Dist - - fro--m-_ founation_ . __.____ _© Material---[® C_ - ------------- Disposal a�No. of compartments-----�----- --Size-- CX .__.Liquid depth____ Z ____._Capacity____�'- y - -- Disposal Field: - 'Distance from nearest well..SOn_----Distance from foundation-___l __'__._.Distance to nearest lot line----,,311- vl.. h . Type of filter material_ Q- 1iDepth of filter material. --------- Width of trench__.__ ________—_-t____ Number of lines________ _______________________Length of each line_��'�` ��_____ ----Total length-------------------ZI -------- Seepage ------- p 9 i y_ ____ 1� nce tp nearest lot line_�_�-�__.___.__ See a e Pit: Distance to nearest well-__.0©C�. - Distance from foundation___ ______________ D-sta Number of pits.-----/-------------Lining maferia l_��_�Cl__._.Size: Diameter.---�.$---,�-_--Depth------ -��------------------- � Cesspool: Distance from nearest well_________________Distance from foundation__._....__._______ Lining material---_________-___._.____.____________ (•1 Size: Diameter------------------------------ -------Depth-.--------------------------------- ------------.._Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_------------------------_-------------Distance from nearest building N ❑ Distance to nearest lot line--------------------------------- ---------------------------------------------------- Remodeling --------------------------------------------------Remodeling and/or repairing (describe):--:- ----==---------------- ---------------------••----------------- ---------_--------------- --------------------------- is►. ' ---------------------------------------- - --------- ----------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San,•Joaquin County ordinances, State laws, and and regulations of the San Joaquin Local Health District. {Si ne gd) ------- ----- - -------- � ________________(Owner and/or Contractor) � Plot Ian, showing size of lot, location o s stem in relation to wells, buildings, etc., can )laced on reverse s _ !` Yom, -1 ------ •. -. Title = -- R=_= ------ (Plot g Y 9 p side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Tf _-------------------- -------------------------------- DATE .'_. ' i REVIEWED BY =--------------------------- -------------------------------------------------------------------------------:--- DATE - - - BUILDING PERMIT .ISSUED---------------- ---------------- --------=---- -------------------------------------- DATE. �► �T Alterations and/or recommendations:-------._ROC.�4. .1 1 ,. _1. .S_._../nf__----- ' --- f/--------- ` ► �rr_..�1_N ® TA...i nr®'r ln�_ >1 .Cr.�D -1 KI-Q-t-------------------------- T-LA --------- ----------- ------------------------------------- --- ----------r:;--:------------- .._ ----- ------------------------- -------------------------------------------------------------------------- ---------------------------- ----------------------------------------------------------------------------_- -- -- - = -------------R - ---- -- - ------------- -- -- ----*,-- FINAL INSPECTIO ----- ----- - Date..., -• `� -fa. . SAN JOAQUIN LOCAL HEALTH DISTRICT') 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. i