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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT Permit No. .J.`t.a. - z— -------------------------- --------------------------- (Complete in Duplicate) �- - _ Issued Date Issued ---------------- .--- is Permit Expires i Year From Date I zZc� � lSor•Ch Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the IN This application is made com li`*ceith County Ordinance No. i49. 304,7 2 PP Xye. JOB ADDRESS AND LOCATION.E-4 r � _ R _ __..RIS_ _r?I___�_--OF..Vo"g....,N Owners Name.......L..�U_4�r—..-......... VF,=t,AN-IJ Phone �hh Address----- l K . asi •-- -------;-W ------\44 fir ---- V�i�-------------------•-•.....----'-.... --- -•----•----- --.... Contractor's Name 1 — — -- --------------`------=---- ......--------...------------ '^ gtz Phon .. Installation will serve: Residence+Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ vit � � i - Number of living units: a TNumber of bedrooms S.'_ Number of bath's 0*- Lot size:.-:5.� ::._{�---_------------- Water Supply; Publics stem (f_0m` nit s st m Private eDe th to Table Y ❑ Y Y ❑ P I " Character of soil to a depth oi3 fe f Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ CIay ❑ Adobe❑ Hardpan Previous Application Made: (If`yes,date-N.hi LA_1.1)INo @New Construction: Yes gNo ❑ FHA/VA: Yes FT-_'INO [] TYPE OF INSTALLATION AND.SPECIFICATIONS: - (�i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C)- a Septic T Distance from nearest wall.... Distance from foundation----ZO--------Material---_______NC.�-' �.___•.-_-. No. of compartments--_.--' zeK ....� Q Disposalwell N Feld: Distance from nearest well_--i -._.Distance from foundation.____ O______-Distance to nearest lot line... ��+.. [ / Number ofIlines---- ___ ____________________Length of each Iine-`�...';P Width of trench__ _ _.___= ___---- AF _ Type of filter material._.JRQC 4%._'___Depth of filter material.. 9-v---�___._..Total length---------- Q_________________ f , ._.___.Distance to nearest lot Seepage Pit: Distance to nearest well__��___-___distance from foundation__. kKNumber of pits-------/------------Lining mate rial____)V.iCA---Size: Diamete r_'S—X-0?rn-_.,Depth__.-../`e ---............... Cesspool: Distance from nearest well_________________Distance-from foundation--------------------Lining material-----------------------------------__ 13 Size: Diameter-------------------------- --- ------Depth.-•------------------------•------------------------Liquid Capacity---------------------------- I'S. Priv Distance from nearest well -----------------t__ ______________._Distance from nearest building ❑ Distance to nearest lot line--'-----!---------------------------------------------------_....... ----•---••--------_------__............ -----•- ,.._- t � Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---•---••-----•-•---------------•------•-•--•----------•......---••----•-••--- -----•• .......I....... .*_.-.-.----•---..._..---...------------------.......----..._........--••----•---•-------•------. 1 I i --- �1 I hereby certif that have pre arad this a 'cation and that the work will be done in accordance with San Joaquin County ordinances, State s d rules regul, nsea he San Joaquin Local Health District. {Signed}. = - --- -: .-- -------- --------------------------------------- ----=-`--•--•----------(Owner and/or Contractor) �r• = -----=------- ----------------------------------------------------------------------------- Erdal...-�-------------------------------- - (Plot plan, showing ze of`lot, location of system in relation to wells, buildings, etc., carfbe placed on'reverse side). FOR DEPARTMENT USE ONLY ++'a { PLICATION ACCEPTED BY---------- _ft-.0------------------- ------------------------------------_ DATE.- -. 7i�_�'-----....37.1 - 2---------------- REVIEWED BY---------------- ----------------------------------------------. DATE.�s !'_'.---- --------------------------------------- BUILDINGPERMIT ISSUED..............................................................--------------------------------------- DATE----------------------------------------------••---•----•--•- Alterations and/or recommendations:---------------------------•-------• -------- --------------------------•------------------•--•-----•-•--••--••---•--------•-----------•--------------•----- FINAL INSPECTIO - - - ------------ -- Date---------- ��© SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 AEVIEEo 8-g9 RM 5-EI AtLAS