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rUKUrkl(_L USE: V s - -- --------- ---------_____._____._. '" APPLICATION FOR SANITATION PERMIT Permit` No. ._/fI"_. >" 3 (Complete in Duplicate) n+oJs'7" ro This Permit Expires 1 Year From Date Issued Date Issued rJ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workf herein d scribed. This:application is made in compliance with County Ordinance No. 549. -'SOB ADDRESS A �p01bAT10 ---ory -_ .-Mr.10F.......59 r CA------- --- ------------------ Owner's N-ame="P _ .- ----------: Phone Contractor's Name____-�(_/�f F ------------------------------ --------------- ----- ----------------------•-------•---- ------------------ Phone---_�--------------•--------••------ ` Installation will serve: Residence' El Apartment House ❑ Commercial ❑ Trailer C�mr� ! .0Motel 0 Other ❑ Number of living units '" _ / �}� � "-__ Number of bedrooms -- _ of baths -_-/-._ Lot size ____4.0 R F---_- umber' f Water Supply: Public system .❑ Community system ❑ Private ^ i -�.v p Water Table _ 7_ ft. Character of soil to a depth of 3 feet: Sand 3 Gravel ❑ Sandy Loam ❑ Clay" r� Clay+ ❑ Adobe❑ Harden Previous Application Made: (If yes,date_.._. t ) No New Construction: Yes FHA VA: Yes ❑ No TYp OF.JNSTALLATION AND SPECIFICATIONS-_. - - T� f ; No septic tank or cesspool permitted if public sewer is available within 200 feet.)"' Septic Tank: Distance from nearest well___,57-0---_Distance from foundation_ // l � .::.,-r '�! o. of"compartments- - �- ---Size-a.� - -h'�-------- - 11r a �"--�------- � -- --. : !ti' "� .Liquid depth - it.; Capacity-__9 W Disposal Field: Distance-'from nearest well ,� _`-_Distane '-from:foundation_._ /q0_t..�____.Distance to nea_r_.e.-s_t_ lotNumber of Irnesjoeachline__ :^ Q _en ts -. Width of trench--Type of filter material---R_0-_CKc.rDep+hfof!flte 'material-_._ I ___Total length___M _-__- Seepage Pit: ,, Distance to nearest well:.____-±__:__ ___..__Distance from.foundation___________________.Distance fio nearest lot line__.__..._-____.._! }'{� Y ❑ Numnber of Arts --------Lining material_ ------- ------------Size: Diameter-------- --- --------Depth------ p €nce ' nearest'weI 11+___-.-__ -------------------- '/'D is+ance from foundation._- .._.. ___..Lining material] .-Cesspool: Size a Dia titer-n-A--µ-':��rc_c [ A -- �----- Y Distance from nearti Depth Liquid Capacity--- -------- gals. t Privy: est well______-----------------------------------------..Distance from nearest building "'k 1 ❑ Distance to nearest lot line- f' -----------------------------=--------- Remodeling and/or repairing (describe):-------- -------------------------- ---------------- / ' - _ -------------- -------------•----� ---------- ------ - _r �. ,-------------------------------- ---------8 _ --- + ,. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County < 3 ordinances, State laws, and rules and[regulations of the San Joaquin Local Health District it s . — = 1 [Signed} t . r ----- --�---- v --------- ---- -�-- - �-•- --- -------� -�-[Owner and/or Contractor[ i€ ._ ,r... lY= -•-- ------- = -------------------------- — �[Ti#te):�'..-� _ -- -- ( of plan, showing size of lot, locatioti.of,S'ysie;A.iniel'tion to wells, buildings, etc., can be placed on reverse-side). t r FOR DEPARTMENT USE ONLY I APPLICATION=ACCEPT€DC7. --------- DATE------ ' -' REVIEWED .BY----- ------- ------------ e ------------------------ ---------- DATE - - i BUILDING .PERMIT ISSUED------------------------------- ----- --------------•----------------------------------------------- DATE --•------------ Alterations?and/or recommendations:._----- - ._...______._ ------ -------------- ------------ ------------------------- _. -------------------------•---••---- -- ---- -- ------ i --- --- - --- r r FINAL INSPECTIO --.. . - Date------------ ------------ r/ F , SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E,'Hazelton Ave. 300 West Oak Street 124 Sycamore Street,' - 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California