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FOR OFFICE USE: a� ---- --------2-4_.K � �� APPLICATION FO.R SANITATION PERMIT Perini+ No. r ��l-- - ------------------------------------------------ _ --,,� 1 ,,.----- -----------------------------------------�-�-- Complete in'Duplicate] Date Issued __�-�:�� ------------------------------ ----------------__ This Permit Expires 1 Year From Date lssued--� Appliea+ion is hereby made to the San Joaquin Local Health District for a permit to constru\and install the work herein described. This application is made in compliance with County Ordinance No. 549. ---------------------------------------------------------------- r JOB ADDRESS AND LOCATION.-._ --/-D------ � Owner's Name----------- ..S-----.-ce ry v1 r----_ g�l f�l6z�.his✓1-5--------------------------- Phone-------------------------------- Address---------------------- F r/ ter ' Contractor's Name -' 1 "--------,.. 1r1 �------- tet' — Phone__ � �� "` Installation will serve: ;Residence Apartment House:E] Commercial ❑ Trailer Court ❑ Motel 0 +,.Other ❑ I t � - - Number of living units: __�_--- Number of bedrooms __/ Number of baths ---I---- Lot size _M0_f_YA9& -------------------------- ----- s Water Supply: Publicisystem ❑ Community system[] Private $ Depth to Water Table _P0 ft. i :--Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E� Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: „^ g (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) Septic Te . �1• Notance from .nearest well-----------------Distance from foundation--------------------Material____._.______-_--_---------------------.-___--_. � d r. of compartments-- ---------------_- ---Size--------------------------------Liquid clepth------- ------ ---------Capacity----------------------- � 1 I Disp sal Field: Di Mance from nearest-weli____q-------Distance from foundation_---10 10_1------- to nearest lot line-_-•�_-.----- �{� Number of lines______________t- ---___Length of each line-------- ________.Width of trench------- _A_111 Type of filter material._ ).®FrjL...__Depth of filter material-----� ______..__-_Total length--_A__-_'7 --------------------. r Seepage Pit: Distancelito�fnearest,well----------------------Distance from foundation___-----------------Distance to nearest lot line_____.-________._ ❑ Number of,"Pits-----------------------Lining material-----------------------Size: Diameter---- -- -------------Depth----- --------------------------- 4 r i - Cesspool: 'Distance from nearest well-----------------Distance from foundation--------4i__.;__.Lining material--------------.-----.-.-_-_---_------. ; Size: Diameter.--'---- I------------------- --------De�th - ----- --------- Liquid Capacity----------------------------gals. 11 Privy: Distance from nearest well-------------------`- ----------k_.... .Distance from nearest building-_---_-------------------------- r z j i Distance to nearest lot line x--------------- --" ---------- . < . I Itc Remodeling and/or repairing (describe):---.----_ _ ._�_,._ a ---------------'---------------------+-------'------------�+------------•------•---- 4-`--------_.-_-_-_-___.__._.._..._ ► ` I hereby certify that I have prepared this application and that the work will be done in accordance wit0S.an Joaquin County ordinances, Sta laws, and rules and re ul o s of the San Joaquin Local Health;District. # _" ?0 + w er and/or Contractor d � - -- 01-f .j `_ E / I (Signe ) �� - -------- ----------------- 1-- —- Title i �� (Plot plan, showing size' of lot, locatio of system in relation to yells, buildings, etc., can be placed on reverse side). C t FOR DEPARTMENT USE ONLY r / 1 APPLICATIONACCEPTED BY------ t ------------ ---- -- ---------------------------------------- DATE----...'7 ------ ---------------------- REVIEWEDBY---------- -- ------------------ - ----.__..------------ ------------------ ----------------------------.... DATE---------------------I--------------------------------------- r BUILDING PERMIT ISSUED -------------------------------------------------- DATE ----- Alterationsand/or rec6mendations------------------------------------(- - -------------••f---------------- •---------------------••----------•------------------------------------------------ !. !� --------------------------------------------------------------•---- ----------------------- ------------ k R ' ' R . ---------- -- -- ----------- ---- ----------------------------------------------- ---------------= ----` _---- --i--------------------------------------------------------------- ----------------------------- ------------- - ------------------------- ----- -- --------------------------------------- --- ------------------------------- ----- --------------------------------------------------------------------------------------------------------------------- Il ------- C Date----------- ---- � - FINAL INSPECTION BY:� � SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California r F.P.0 C. f'