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[-UK UI-rlLe USt: ------------ ------------ U _- ------------// APPLICATION 'FOR SANITATION PERMIT Permit No. e✓./..- � .. ------ ----------- -- ------ -------------- (Complete in Duplicate) ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued l4- -4 5L Application is hereby made to the San Joaquin Local Health District for a permit to construct yd install the work herein described. This application is made in compliance 'th County Ordinance No 9. c�tud-.4— JOB ADDRESS AND LO ATION__ __ _------_ ®_ _ _C_''_ _' / /f/QG�--__ 'S' �__ r Owner's Name_--A t9h = ® �h C� T i t - Phone_ ~1�.®Qr Address------R-`it-11------ ��{� y� - t------------•----- ,�` ` dry Contractor's Name_.H . . .LT--- ------ ------ ----•-- k-.----f-.-.•--- Phone.'7`fv.�?-", .Q-7` Installation will serve: Residence A artmen�Hous y� Ouse commercial Trader Court Mot ®gyp ❑ ❑ ❑ el ❑ �OtkerNumber of living units: ./_.___ Number of bedrooms Number of baths -__�. Lot size ___ --__._-. -- -------------- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 2--J'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay E]�y [] Adobe Hardpan Previous Application Made: (If yes,date--------------------1 No E] New Construction: Yes 0 Nom FHA/VA: Yes E] No F]TYPE OF INSTALLATION AND SPECIFICATIONS: ,f (No septic tank or cesspool permitted if pub c f sewer is available within 200 feet.) Septic Tank: Distance from nearestelf d).-----Distanje from fou a� n--I 0--------- Mat rial-No. of compartments_ �a/..... ........_.__Size�__ _�� Liquid depth_ _t� Capatity___ 0.11 Disposal Field: Distance from near st welL_ "._ ___.-.-_Distance from foundation_��-.Distance to nearest lot line__ �_ AX Number of lines_____ __ __ ___ Length of each lined ___. __.Width of trenc#��!t__-___.._____ f Type of filter materi ____Depth of filter material____ -----Total length------------- r-- App Seepage Pit: Distance to nearest wel__ - - -__-----Distance from foundatio _____ Di t to nearest lot fine_ 1------ �' Number of pi ___-_-_-__Lining mat _ Q Size: Diameter___ _ __ _ __________Dep n_ Cesspool: Disfance from nearest well-------------_---Distance from foundation----------------__ Lining material___-____-.-_-__--.-____---_-_____. ❑ Size. Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity--------------- ---------..gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----_.-__-__._____-____________._____-._. ❑ Distance to nearest lot line - --- ------------------------------ ----- ----------------------------------------------- ----------------- ------- ------------ Remodeling and/or repairing (describe):-------- --- ---- ------- ---------------------------- -----------------...---•-----------------------------t-------------------- R- -------*-------------------------- -------"-- --------------------•---------------------------------------------------jV--------------------------------- ------------------------------------------------- -- 1 t F hereby certify that 4 ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aajAwles and regulations of the San Joaquin Local Health District. 44. 41F f69 (Signed) TRV ---------------------------------- (Owner and/or Contractor) r 291.5 E.Miner Ave., , HO. --------Title ----------------------------------- -- Ils ----- -- - ---- -- (Title) (Plot plan, showing size of lot, location of system in relation to Ifs, buildingsAetc., can be placed on reverse side). J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .a- --------------- ------------------------- DATE----,/a REVIEWEDBY------------------------ ------------------- ------------------------------------------------- DATE------------------------------• -- BUILDING PERMIT ISSUED----------------------------------------------------------------------------.-.----------------- DATE---------------------------------------- ------------------- Alterations and/or recommendations--------------------------- ---•-------------- -------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------ ----- ------- --------------------------------------------------------------------------------------------------------------------• --•---------•-------------------------- ------------•---- , FINAL INSPECTION BY:. _ LL:1 -- --------- Date-- - -W_45 1 5-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.a u.