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r-UK UffML-t L16E: _ ya ---------------------------- ------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. .. _1 ?:: - --------------------------- ----- ----------- Duplicate) ` Date Issued -1_ _--?__.6 -------------- -------------------- - ---- --- {�`. rom Date Issued Com lite in -----. -- This Permit Expires 1 Year From _ 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 County Ordinance No. 549. Esv9c.t� , _ ISN �C Lply L LD7'7`14 l JOB ADDRESS AND LOCATION----------- DIVI ----- ------ ------� Owner's Name------ -_ :��- 14 --•----- --�--------•-------'-•----=---------- --- ---=-- ------------------- -. Phone----------------------------------- Address---•---------�_/_5z- G fJ_ --• 4S.CR Contractor's Name-------- :... Phone.--...._ WN ---------------- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livings nits: '-__-Number of bedr Water Supply: Public ooms _'5__ Number of baths -_l--- Lot size ----- S. _•,�� tem`❑ . Community system' 3q❑ Private �ep#h to Water Table -tt. _ Character of soil to a depth of 3 feet: - Sand El E] Sandy Loam E] Clay Loam Clay 11 Adobe Hardpa f Previous Application M d : ,[I[If-yes,date--------------_ No New Construction: Yes No E] FHA-/V :`Yes No —TYPE`OF-INSTALCATION`AND'SPECIFICATIONS ' � � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic nk: Distax ce from nearest well___,'_--Distanc from foundation AQ Mat ria---�A9^i (:;ham i No, of c partments�' _-�Siz - � Liquid depth ._ �_ ---.Capacity / 0-p. Disposal field: Distance:fromsnt arest+-w)e f_-, Distance #tom oundstion k!-®.__ Distance to nearest lot Number of1lines /p---- /� ------- -_--Length of ehF line---:�r��_-_ '_.w/idth�of trench_._---��----------_1--- z k Type of filter material---IL_Q-C,, ---Depth of.filfer material__._-_ qq I � , ; w /r Total,,�length- Q w Seepage Pit: Distanceo�nearest�wolL___ .____Distance�ff om found #ion__--/D•• istane o nearest lot line-_.__ � � - Number of pits..._ �_--_--___Lining materibl_-904C_ _Size: Diameter-l�X-.�__ .. Depth.-------r��-------------- Cesspool: Distance from nearest well____---_.--_-_-- istance from foundafion----___--__.-.-----Lining material--------------- ❑ Size.: MameFer----------------------------- Dep t - _-Liquid Capacity...-------F`------- gals.A Privy. Distance from nearest well------------_-- -- ---- -------------- - Distance from nearest building--_ ________ _____________ r ❑ Distance to nearest lot Ione___--____ t -.,x tr 1.A ioV4"r 0 ----- - -------------- - --------------------------------------- = "" +�f ---- ------ r - Rem odeling and/or repairig (descr(]-------------- - ------ ----------------------------- ---- - ---- ------- ' ---------- ------------------------- --•-•------------------------------------r.' -w-- ----1-------------- k ° . - , ti ------------------i------------------------- -7----------------------- ----------- ------------------- --- -----------------------------I------ -•-- - ------------- ---------------- I hereby certify that Ihave4prepared this application and�that fifi wo k will be one in accordance with San Joaquin County ordinances, Stat laws, and rules and regulation the,'an Joaquin Local Health District. ¢ 5i ned f 9 } 111=`_f_ •----- � ------- -------------------- caner and/or Contractor) : - -_ ---------------- ---------•----- ---- ------- ----- ---- "(Title};_....- - (Plot plan, showing size of iotJldeation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------777TR_-V---------------------------- - ----------- DATE--- -E� --------------------- --- 1-7 REVIEWEDBY - --------------------------------- - ------------------------------ ------------ -------•--------- •--- DATE-------------- I ------------ ---,---------:---.------ -� BUlLDING,.PERMIT..ISSUED r �� 5Q'� �AP -- ,DATE :._ - = - ----- ----------- --�.. �. , . ._. �.....,.... ... .Y....,..,.� ----------- --•----------- ------ ` tions•------- ---- ----- � �.� �N j`aT�_-------!:— r�fG-- -'-t .l+ylr ! r ocTT- ., -- -y-------- ---------------- - or recommen a --��-------��'��p�# -'-----------=t�+�a�s_�cUs-----------Sir} -------�P�}.A�-------- ------ t�l _.R F_ f --rte 1 - c - e_�---�_------------- �c--i�__0........ ------------- ---------------- FINAL INSPECT N BY:__ Date ---------------------..:-/ _.-_ls - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 5,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ti r'