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rUKUFFICFUSE; - I . _. _. -------------------:---------------- -------------------- 4 _---------------------------------- ----------- -------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) Date Issued _7:�__2��-7:41< ---------------- --------- ------- --------- --- This Permit Expires I Year From Date Issued t4 Application is hereby made to the San Joaquin Local Health[District for a permit to construct and i:2nstall the work he described. m This application is made in co oliDnce with County Ordinance*'N'o. 549. JOB-ADDRESS AND ------ Owner's Name----------- Address_ RTE------- 13-o-X----------- - --- ------------------------ ----------- Phone--- -------------------------------- ---- _76----- ----------- Contractor's Name--------CA-RGILIf .04;4-�j------------------------------------- ------ ---- Phone------------kk - • Installation will serve: Residence ED] partment'House-El-v-Commercial D Trailer-C-ii ET' Motel D Other D Number of living units: __-/--- Number of bedrooms j---- Number of baths Lot size ------------------------- Water Supply. Public system D Community system E] Private JR`Depth', F9;,Wafer�abI17, i4__�__ Character of soil to a depth of 3 feet: Sand PT"Gravel D Sandy Loam D Clay,Lo-am Cj--Cla� (j]j,#%Aclobe 0 Har an E] _d Previous Application Made: (If yes,date___________________) No,e-*?--_N_ew Construction: Yes D. El FHA/VA: Yes D No —TYPE,OF4NSTALLATION AND-SP-EGIFIGATIONS:-v��_-; ties' (No septic fank.or cesspool permitted if public sewer is available within 200 feet.) _ t t W Septic Tank: Distance from nearest weil----5 ---Distance from foi7-5-d ion-_1_6--------MI teriaI____C0NC.PVa__7__E_7_ E;_`9 No. of compartr�erifZ772— ------------ --Q-I -Liquid depth- Capacity----0-0-P---- D;sposal Field. Distance fromrparestiwell-��_V...Distance from foundation-----A:9------- Distance to nearest lot line Number of ------------Length of each line--------AW..... Width of trench--------- - -------------- Type of filter material__-RO_C-K----Depth of filter material_----- Total length------------- ---- - Seepage Pit: Distance to nearest well....... --------------Disfan(�e from foundation________________-- Distance to nearest lot line_._____-_____.___-- 1771 Number of pits-_'-------------------Lining material---------- ------------Size: Diameter-----------------------Depth-----------------__----- ---------- Cesspool Distance from nearest weJ1-----------------Distance from foundation----------- -----.Lining material-_.___-_-____-________._- ------------ .Size: Diameter-_!------------------ ------ -------Depth--------------------------- ------ ----------------------------- I ---------- ---Liqu;d Capacity------ -----------------gals Privy: -Distance from nearest well________________.----___.._____________---_ --Distance from 'nearest buiidin❑ g__.__. ' Distance to nearest lot line--------------- : J ----------- ----- ------ ----------------------------------- Remodeling and/or,repairing (describe):_____________________________- --------------------------------------------------------------------------------------------------------------------- ---------------------- -------- ----------------------------------------------------------------- -------------------------------------- ------------------------------------------------------------------ ----------------------------------;t I Ik , -------------------- ---------------------------------------------------------------------- -------- ------------------------------------------------- ---------------------------- --------- -----------------------------------------------------I--------------------------------------------------------------------------------------- ---------- - ----- ------ ------ -- - - -- - I hereby certify that I have prepared this application and fhe4 the work will be doneinaccord-a-nce--wifh--San--J-o-a-quin---County I - - - . ordinances, Stat ja!ysi and rules an egulations of the San Joaquin Local Health District. T (Signed)-.--- "8 __.G------ -----------------------------------------------------------------------------...(Owner and/or Contractor . �. — -q-_t- By:----1—771* ------------------------- -------------------- -------------------------------------- - - --- ---- -- - - ---- ------ (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed--on--re,v-e-rse"side)--- ----------- -- --- ... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------775 ------------------ ---------- DATE- ------------------------------ - REVIEWED BY------I ` I -------- ---------- ------------- -------I------------------------- ------------------------------------------------------------------- ----------------- -4--' — _ -------- ------------------------*�---------------------�-------------------- DDAATTEE----------------------------BUILDING PERMIT ISSUED-----------------I---------------- - -------------------------------------------------------------- - -A---lf--e----r--a----f--i-j--n-- ------d--/---o--r--recommendations: eco�-_-_-_4------n--d---a-f-i-6--n--s-.---_L---------------------------------------------- <if ---------------------------_----- --------- ---------------------------------------------- --------------------------------------------------- --- -------- -- ----- ------------------------- -------------------------------- - -------- - ----------------------------------------------- - ------- ------ ---------- -- --- ------ --------------------------------------------------------------------------------- ---------------------------------- -------------------------------- -------------- --- -------- - ...... .. ... -1- ----- - --------------------- ------------------------------------- ----------- - .......... -------------------------- FINAL INSPECTIONIB.Y._�, - --------- -- Date_-.---- - ! _1.f7_ �-- SAN ate-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California