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F FOR OFFICE-USE "" : APPLICATION FCR SANITATION PERMIT Permit No. 7,7 ----------------- --------------------------- ------ --- - (Complete in Duplicate) Data Issued _---"--- -_. This Permit Expires 1 Year From Date Issued Application is hereby made to thel San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. •w 'r � 1?l� l�S &Wr JOB ADDRESS AND LOCATION__1011 44/ ." Jild__5_T_ ,lA#T4�A CA41 -----------------------------`----------- Owner's Name------ _A._" _ .f --------------------------------------------- ------------------------------------------- Phone O.2 3.... 4� " Address f `' ' __s _• _t ` -f iF---------------------------------------------------------- _ tor s Na ePhoneg,2_3 ----------------- Contractor's Contrac ' t7�✓/`,�' �� `. �awN------------------------------------ -------------- Installation will serve: Residence Apartment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__-- Number of bedrooms A--- Number-of .baths j____ Lot size J--_ - / -------------------------_--- Water Supply: Public system ❑ Community system [-I Private [§Oo Depth to Water Table _1 - ft. Character of soil to a depth of 3 feet: Sand 9!( Gravel 171Sandy Loam ElClay Loam ElClay-E] Adobe C] Hardpan ❑` Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No E4**� FHA/VA: Yes ❑ No E�� TYPE .OF I-NSTALLATIOWAND.SPECIFICATIONS: _.._ �,.. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ryrywefL > __"-___Distance from foundation) ____.______.Mate!I____ONG-�� _------------------- No. of compartments_2---------- --------Size�__4,e_--3---YK-----Liquid depth---We.-..---- - "--Capacity y. f Distance to nearest lot ------ El e_fZ__._____ Disposal Field: Distance from nearest well?@..f__._Distance from foundation-,/-'/---------- ❑ Number of lines----/----------------------------Length of each line__��0.- - -------- Width of trench.4—t---.------------------•-- Type of filter material.QY*A _K4ZDepth of filter`material-��'---------------Total length------ 0Q__`------_____________.__ Seepage Pit: Distance to no well_______________..._--Distance from foundation____________---___Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter* Y Depth_------------ ---------------= Cesspool: Distance frominearest well-----------------Distance from foundation________________"s:Lining material_._.___.__.____.. _--_.________-_._ ❑ Size: Diameter---- -- ---- -----------------------Depth------------------ ------=------- - --------------- -est Capacity gals. + Distance from nearest buildin Privy: Distance from#nearest well-----------------=--------------------- --- I .. 9 - 0. Distance to nearest lot line ------------------ ------------- ------------------••------------ --------------------------------------------------------------- -------------- y-+ Remodeling and/or repairing (de tribe):"/.� /,4• .1 � , �C [� '------woo-D"V---- A-AIIt�---.�_jdi✓ .a- --' +# r.. e ---------------------------------- ------------------------------ ------ ---------------------------------------------I-------------------------------------------------------------------------------------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done,in a}ccordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.;f (Signed) L• - } ------ ------- --------- -�t- --------- -- caner and/orIrl (Plot plan, showing siz to , l catto stem in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY c - 'f � / �lf= APPLICATION ACCEPTED BY --_�(-�-'---------------------- ----------------------------------------- ------- DAT F -------- r- 1 REVIEWED BY------------------------- ---- ------------ ----- ------------------ ------------------------------------------------------ DATE----------- -.7 �- ��-------------------- I rT BUILDING PERMIT ISSUED--------- •-------------- - - ----------------- -- DATE. - ---------------------- - i Alterations and/or recommendations:------------- ---------- --------- -- --------- --------------------------------------------------------------------------.------------- . . f' ---------------------- f. ----------------------------- I ------------------------------------------------------ ------------------------- -------•--- --------- ------------------ ----------------- --------------- - ----------------------------------------- - - •---------- --------------------- ------- ---- r -,:77j_f FINAL INSPECTI s� � Dat - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California A.. Lodi,California ,A,._-Manteca,California Tracy,California