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FOR OFFICE-USE: - ---------------------------------- -- .---- -. APPLICATION FOR SANITATION PERMIT '""" Permit No. ..�.l1.rz�. ..� ------- - - i-- -- --------------- -------------ri-- - ,.- 7 (Complete in Duplicate) Date Issued ..�?f7Z ci m . - This Permit Ex ires 1 Year From Date Issued Z 7eo--Z<3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work herein described. This application is made in gompS,ncceE ith County Ordinance No. 549. t RI PON Al 4 JOB ADDRESS AND LOCATION---•------------- i `� I'G ECS. GOQ ®rFi_I'�� Owner's Name----------------------------Fare_N__5-°N------------ -------- -----------------$------------- Phone-----•-----_-----... ............ Address---------------- p ; i Mil _-. Contractor's Name---------- -------------------------------------- one -----------.".`-.:-------- •----- Ph ................................... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑r Motel ❑ Other ❑ Number of living units: ---- Number Number of bedrooms -- to ._ Number of baths _--- --- Lot size_:-- .,.�.._-A_�__R�-•_--E►-`-f-ink--'-------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table,---- ft.'s` Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑* Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------------_--.) No e New Const udion: Yes-E]—No FHA/VA: Yes ❑ - No TYPE OF INSTALLATION AND SPECIFICATIONS: �, (No septic fank or cesspool permitted if public sewer is available within 200 fee+.) Septic T k: Distance from nearest well-5.0----_Distant from_ foundation-10----------Mate�rial-'r`-.�'67A/CRE"T� � No. of compartments-__--� " Size--�X1PX--5__-__ Liquid depth--._ Ca�- p y-_. -------------- - pa .Z QG7 �.r=�.. Length of each line--- dr--- o-Width of trench........ �--- Dis osa geld: Distance,,from nearest well.._.��_--.Distance from foundation--_- p 1�. ..._-_-Distance to nearest lot line----------------- Numbed of lines ; le Type of filter material---R0_c_' 'Depth of filter material----- -9. __.Notal length_----;�/_57�----1------_--.-- Seepage Pit: Distance to nearest welLi--------------- =-Distance from foundation--------.---------- Distance to,nearest lot line----------------- - El ._ umQSer of pits Lining material "- ------Size: Demeter.---" ---------- Depth--------------------------------- Distance from Cesspool: Size: Diameter�neares- well===----------=---DDeptince from fou 'dation------------------ �'nU x - _.til ad ,,�-t ,.❑�.,�_ ^; qui. .P ,ty--. ----- -----9 Privy: Distance from nearest well ---------------------------------------------Distance from ne'�rest building------------------------------------------- 171 .____ --:----------_.-----_.---..-❑ Distance to nearest lot line ' _x------- ---------------'--------------- -- ---------------------- -j Remodeling and/or repairing (describe)::- -----. - ---------- �" / 3 t. € -- ------------------ ------------------------------- 1 li~1 7aPt- -cam !�D _ .s7 - - ------ - - - ----------- --- ----------------------------- - -------------------- --------------------------------------••---------------------------------------••----- ----- ------------ ---- n a ----- I hereby certify that I have prepared this applicationd the+ f6 work will Iae�idone in accordance with San Joaquin County ordinances, State laws, and r les and regulations of the San Joaquin Local Health"District. ° -- ---- --------------------------- ^- ------.-:-{Owner-and/or Contractor)- (Signed) ---- - _ By:__-------------------------------------------------------------------------------- ----------------------------------------------(Title)---------------------------------- ---- ......................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED •BY-- -- 7T7-F•-4---------------------------- ---------------------------------------- DATE------- 2 T . L- - REVIEWEDBY--------------------------- ------ --------------------------------------------- ----------------------------------------- DATE--------------------- BUILDING PERMIT ISSUED------- ----------------- ----------------------------------------------------------------------- DATE Alterations and/or recommendations:---------------........... - -----• ------------------------...------ ---------------------•-------•-- ` -------------------------------------------------------------------------------------- --------------- ---------------------------------------------•----•------------- --------------------•----------•----------- -------- ------------------------------- - ---------- om FINAL INSPECTIO tK . Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street EiP ,. _ 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F F.P.CO.