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'FOR OFFICE USE: a ------------------------- --- ----------------------r-- ' APPLICATION FOR SANITATION PERMIT Permit 'No: -9__ar/_.�� • lip'- ---------------------- ip-.-------_--------------- - -------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance f No. 549. NI v; ,- Q�r6r-c t 4 _ riaRvA R0 RB OB ADDRE AN OCATION� yr - - -- ---------- •--------- " ' ------ Owner's Name------------fJ1j-TQ.i_E=_..--�_----- V�� -------------------- --------------------- Phone------------------------------------ I Address-------------�7-�- ----- ,G_EW.1.1` Contractor's Name---------jOWWE_�R---------------------------------------------------------------- -----------•-----------------------•-------- Phone----------------------------------- 1ristallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other We--"�r� Number of living-units: -------- Number of bedrooms _-- $EwAaF_ JReATi►"EA Number of baths __..____ Lot size _- -__._____..._ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__------------_----__I No New Construction: Yes R-IT, ❑ FHA/VA: Yes ❑ No i� TYPE.OF:INSTALLATION AND_SPECIFICATIO_NS:s,,,,,=.w._ (No septic tank or cesspool permitted if pu61ic sewer is available within 200 feet.) Septic Tank: Dist �o well--- a n-- -- - Material------------------------------------- ------------ rrT��A `� h � Capacity❑ No. o pat n s e p. P y A � d Disposal d: Distance from nearest well-/Z47 --Distance from foundation.___�Q---------Distance to nearest lot line----r� _-__. Number of lines------ ------------------------ of each line-___B6_G_�______--------Width of trench.--_ ________.____-- Type of filter material---R CA --Depth of filter maferial__._.lq_____-------Total length--------A70________________________ Seepage Pit: Distance to nearest well------_---------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits---------------------Lining material---------------------- Size: Diameter-----------------------Depth-----------_--------------------- Cesspool: Disfarce from nearest welL________________Distance from foundation--------------------Lining material-----------.--------------.----------- ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well----------____ ----------------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line------------------------------- Remodeling and/or repairing (describe):-----" 1''�I 1_ _ ®$ }L�_.._Q ------- f Z r- ------------------------------------ ---------------------------------------------------------------------------------------------------------------•--------•----------------------------------------------- -- --- --- ---------------------------------------------------------•--------------- ------------------------------------------------------------------------------ ------------------------------------- --------------------- .- I hereafe hat I have prepared)h% application and that the work will be done in accordance with San Joaquin County ordinances and rules and regfillalpris of the San Joaquin Local Health District. (Signed . ------P----- -- - -------------------------------_-----(Owner and/or Contractor) , —By:-=-- -------------------------------------- =------`�"--- -�_r::� _�_�.. - �-_� �� ¢,, ��-_�(Plot plan, showing size of lot, location of syst relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTME SE ONLY / DATE_ APPLICATION ACCEPTED BY------ b. _-_ _-_- --------,----------------------------------------------- " REVIEWEDBY--------------------------------------------- ----------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------- ------------------------------------ DATE------ ---------- --------------- Alterations and/or recommendations:____ __________________ _ __ __ ____ --------------------------------- ,� np . ... 13.f .( 0_ .- _14.Ck I L ?------tVi� --------------- ----------------------------------------- ----------------------------------- -------------------------------------------------- ------------ -----•------------------------------ ------- ---------------------------------- ---------------------------- ------------I----------- - ------------- ------- --- - ----- -- - - ----------------------------- ------ i ' FINAL INSPECTIO Date--------------- 21-3 '-'•� ---------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1841 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - F.RCa. :'s