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FOR OFFICE USE: % (---------------- APPLICATION FOR SANITATION PERMIT Permit No.o.P__7S`$� ----- -----------1 -------------------------------------------------------- (Complete in Duplicate) F This Permit Expires 1 Year From Date Issued Date issued -- /__-_ � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No. 549. ✓r 7-1< JOB ADDRESS AND LOCATION--------- 1--------------�-----------M---�-�t------------------ ~ -------------- Owner's Name _I<. ---------_--------_---_-lL' J ©-12E... �7 ------------------I——-- - - ----- Phone.-4J-=t'--'9-7-1--�--1-4 ,1 Address----•-••---------------------jr...S.. ------------------------------------------------------------------------------------------------------------ Con#ractor's Name --------------.�J-12 ...... Phone r Installation will serve: Residence Ix Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other [❑ Number of living units: ---I----"'Number of bedrooms _-4/_ Number of baths J-1-Lot Lot size ----JJ-0.. X_._./_;3_Q.__--_____.___:_ 1 Water Supply: Public system9 Community system [_1Private E] Depth to Water Table .-`a ft. . Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,�date_-- _ ------- No New Construction: Yes ❑ No FHA/VA:: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Dista�ce from foundation-_-_.__--_______.Material---..--------.-._- ..-_-____- _-_--.__-. r ��115-rf� No. of compartments---------------- Size --------------------------Liquid depth---------------- ---------CaPa Y=•-------------------- 1 g` —� Disposal Field: Ct Distance from nearest well____„ 0.- --_Dist:B from foundation-----�_a_� Distance to nearest lot line_--_-- _._.___. I. Xf S'rlr► _ Number of lines'--------4----------------------Length of each line-------4,_a'...._.._-___.Width of french.......... --------------_ Type of filter material__S?c__ko_dJ/ __Depth of filter material........-le Total length-------------------- --------- Seepage --_-__Seepage PiS-F1rj Distance to nearest well___ G�O_�._.--_Distance from foundation------2D_-__-.Distance to nearest lot line--.--- ,�?(II< Number of pits----------/-----------Lining material---- c-maize: Diameter----- .--.----Depth---------�>J''__-------- 1 ' Cesspool: Distance from nearest well__.------------Distance from foundation_-'-____--------Lining material--------------------___-_____-._--. ❑ Size: Diameter---------------------------- ---------Depth_---------------------------------------------------Liquid Capacity-------- ------------gals. Privy: _._Distance from nearest well----------------------------------______ Distance from.nearest.building_._.------<:..__'_________:___:¢---.:___--- '- --------------------------------------------------------I----------------------- ------ - --=---------------- Remodeling -------Remodeling and/or repairing (describe):---- ?>-,D--------J0---------�e-?c r,S Z 5'�------`t!ta7- =-------z= �- 9 --�- - 4 - r !' ---------------------------j--•------------------- ---- . - ---------------- -------------------------------------------- I - a hereby certify that I have prepared this application,atid..that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District: _ ------------------------------- '-. (Owner and o' #Contractor (Signed}----------- �- - - � -------- --- ----------------- � ��'`"=-------- - -- - - / - ) . t 1 �y------------------ -- — G--- -------------------------- (Title}_ _ (Plot plan, showing size of lot, location of system in rete n to wells, buildings, etc., can be placed on reverse side). : } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... `- -- ------ -------------------- DATE = ` �'3--- - ' REVIEWEDBY -------- --------- ------------ - -----------------`- --------------------------------------------------- RATE'-` - - BUILDING PERMIT ISSUED_..,;--------------------------- ------- ---------===---------------- DAI TE---i------------------------- `--;-----------;---- _ q.z, E . Alterations and/or ecammendeftans:__.T_ __-- - .,M--- ° ' -- - ---- 6` z/J n- — { --- -- -------- f I :--.. } ` # Baa, I jI _ _ , G 1 _ I_ . --------------�.__---- ---- -- FINAL. - 6- -.----t---------- ------------------------------------ SAN - -------- - ----------� -------- SAN JOAQUIN'•LOCALYHEALTH 61SIRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CcIIfornia I Lodi,California Manteca,California Tracy,California q F.P.0 d. - r