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SE:.. FOR,OFFICF USE- ------------If----- _.__._,y.If____ _________________________________ �# --'_______________________________________________ APPLICATION FGR.::SANITATION PERMIT Permit No. .1fI..r ` (Complete in Duplicate] -------- i--------------- ------------------ ---------- --- ---Pp--------------- ----------------- This Permit Ex ires 1 Year From Date Issued Date Issued..L _------------- (Complete .______-_ 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 co pliance with Count Ordinsjnc No. 549, ZATH Raft , 11 JOB ADDRESS AND ON: lUr tl -_CF- LtJ Owner's Name---------- ----------m-o_ w. ------PARK....... Phone e Address-------------AT E--- -•-)-------ek ^� a -------. ---�?5------- A. }m_k_ Contractor's Name-_-----5�_WIV_ �' ------------------__•- i f I ----------------- ------------------------- --------------------------------------- ----- Phone-----••----•---------------•---- I _ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ : Trailer Court Motel ❑ Other ❑ Number of living units:3;;:��munity ber of bedrooms __.'�'- Number of baths _�__ Lot size ___.-.�______A��-_________________ Water Supply: Public system s stem Private De th Y ❑ ❑ p t 'Wafer Table -------- it. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam lay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made: [If yes,date_____________ 1 No 2r"New Construction: Yes No I -- IQ ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION-AND SPECIFICATIONS: (No-septic tank-or.cesspool_Iormitted lfipublic-seweris-available within<200_,feet.)—,_-. .. Septic nk: Distance from nearest welL.7r_ Distance from foundation____.f -......Material_-CO,ICREET.E�_- No. of.compartments......�.._.____._.Size_4X-9`s EI�cH } ---------- -Liquid depth-- �- - •---� Capacity Disposal Field: Distance from nearest well- , �� Distance from foundation---- [---------Distance to nearest lot line__, ________ k'� Number of lines!------- ---------------------Length of each line-------- �___` Width of trench--_.____ H _ ___-----_ -_- FL-'QEF. QS Type os filter matenal- } .--Depth of filter material --------Total length_________________ Seepage Pit: Distance to nearest weft___________..__.__-_-Distance from foundation-----------_-------.Distance to nearest lot line---------- ----- "� ❑ Number of pits-'-------------------Lining material---_______-------------Size: Diameter-----------------------Depth----------------- ---'-------- # } r c r p foundation--- - -------------Lining material------------------------------------ -------- Cesspool: Distance from nearest well______-__--�.__Distance from # 1 ❑ Size: Diameter--=-- --------- ----- De th -- ---- ---- Liquid Capacity ----gals. kPrivy: Distance from nearest well. --.____ ' _________ __ ___ ___ Distancel from nearest building-_--____-______.__--_---_-_------------- r. ❑ Distance to nearest lot Eine----------------- - ------- --------- -- ---------t•-•------- ----------•---•�-- i Remodeling and/or repairing (des��ibe�:-� --------------=-----------------•---------=--------------------------=- ------------ ---------------- --------- :--------a..��_ y ____________ __ a , I hereby certify that I have prepared this appGe ion and that the work will be done in accordance with San Joaquin County ordinances, Ws, and rules and regulations of he San Joaquin Local Health District, r -- A� ---- -- (Signed] ----- ----------- t---------------- (Owner and/or Contractor By. y I [Piot plan, showing sizenof lot, location of,system in`relafion to wells, buildings, etc., can be placed on reverse side]., FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY '+ �Q - ____19_-J3_ ----------------- D A7 E - g REVIEWED BY =------ -- ------------------ --- ------- r ` DATE ------- - P - - Alterations and/or recommendations.- .STS... vd �._ • ._ DATE= ' ---------- ------------------------------------- 1 BUILDING PERMIT ISSUED a �N rA.� A ?V_Jrt ------ ?-------�'�-R-tQ-b-------f�F-----•_ -r-1 145- Q i 1,l -D M0_L CL :._.__ I�_tYp 'f f�Y-N 1�---- `r / Q ar:7 .1. .._.... - 2---- - - --------------------------------- -- .------------- --- ------- ---------------- - --- rr---------------------------------------- FINAL iN --- - ------- - Date-----------2---1 t-----6/ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California *. Manteca,California Tracy,California i 1'