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FOR OFFi jE'` y Permit No. r � Y APPLICATION FOR SANITATION PERMIT [Complete in Duplicate) �. �—�+--'� Date Issued 3 This Permit Expires 1 Year From Date Issued , --------------------------- ------------ ----- --- - - pp #ion is hereby madeto the San Joaquin Local Neal>~h District for a permit to construct and insta4l the work herein described. ALica This application is made in compliance with County Ordinance No. 544. ' JOB ADDRESS AND CATION_______. _ _._- 9s .� _ , _ ----- 47 -•LQ. ' Owner's Name-_.._ �r�. -+ 1�----------- ---- " �` btu - t. P ne Address. -----------�- --t ...__ �},.7 one .. .------- Contractor's Name-------------- -------------•- -------------------- --------------------- Ph Installation will serve: Residence [�pzrfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O# ❑ V------- Lot size _ y Number of living units: , -____ Number of bedrooms -- mb❑er ofU�"" - ----- - ----�•--------- li Water Supply: Public system,❑ Community system Private to'Water Table t. ii: - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ `.-ay ❑ Adobe Hardpan ❑ Previous Application Made:�l (If yes,date---- ---------------) No ew Construction: Yes ❑ No �A/VA: Yes ElNo E3-` TYPE OF INSTALLATION AND SPECIFICATIONS: 260 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well--j ----Distance from foundations(�_____'.._...M, eriai-,CC---_ __ _r�_.0 �. -----.___-__----. No. of ----- 'compartments------ _ vLiquid depth1. __�1�,.C?s---------Capaci#Y�--"-`"----------- p --_ _Distance from foundatioty/P-------------Distance to nearest lot line :.._------ Disposal ___.. Dis osal Field: Distance from nearest well. - : :Width of trench.t __!------------------- ✓r Number of lines----------)__--__ _Length of each l -------- y T e-of.filter material____ a ----Depth of filter rnaterial-__.lf -_._____-Total length------- �_:,l_____________________ Seepage Pi Distance to nearest wel/,d�-/-.____Distance from foundation__. d `=-Dss#ante to nearest jot line__.S_- . ------------ .. -� Number of pits______.______--.---Lining material------�� --Size: Diameter_ , . __- 3..-!j__ _ .-. .---Depth_ ._�.+.� 1. �. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._.------.___:--_______________._. ❑ Size: Diameter------------------------- -- --�`o - ------------------Liquid Capacity----------------------------gals. Privy: _ Distance from nearest well --r__ -, __ g,Distance from nearest building ------------------------ ❑ Distance to nearest lot. fine----- '--=-• ...`-------- ------ ------ -------------------------------I--------------------------- ------ . _.. - - Remodeling and/or repairing (describe):--------------- ------- -----" -------"------------- il •-----------------------------------I-------------------- ------- II - ................... --------------------------------------------- ---------------------------------- I hereb certif that y y have prepared this ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ule nd regulation of he San Joaquin Local Health District. ' -------- (Signed) ___[Owner and/or Contractor) - -------------------------------------------- y --------- ------- ------- ' t, ocation of system t (Title)-- ----------------- --- - -----'......... . --------- (Plot plan, showing size of I y 'n rely#ion-to wells,-buildings, etc., can be placed on reverse side). U FOR DEPART.MENT,USE ONLY APPLICATIONACCEPTED BY----4�-•-----"-1-•----- --------i------------------------------------•------------ DATE--- .----------------------------- 'I ---------------------- ---- -------- --- ------------------------------ --------------- DATE------ --------------------------------------------------- BUILDBUILDI ED ER - - --- -- -�- ` -- #--1-_ti�5 ----._ DATE----------------- ,.., ING PERMIT ISSUED--------------------------------------------------------------- ------#------------- .. ._. .. - -------------' _ L Alterations and/or recomrnendations:,,f�1-- � I , '"-"-" r' �`"------�- ---��---�--------- t ----�- F ' C3•C '-.K�.0-� [A__�.f.- .;l:r�,--------- !! ------------------------- ---------------------------------------- _ ► � fi - ---- ------------------------- FINAL INSPECT B ----- -- ----- Date_ .. SAN JOAQU LOCAL EALTH DISTRICT 1601 E.Hat:elton Ave. 300 West Oak reef 124 Sycamore Street/205 West 9th Street ;I Stockton,California Lodi,Cal' rnia Manteca,California Tracy,California ES 9 kEV16E0 B-S9 3M i 3-'63 F.P.CC.