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ORFICEE: APPLICATION FOR SANITATION PERMIT Permit No. ../ ............... - - - ----�' ./ ------------------------------------------------------ (Complete in Duplicate) �/� 1 / ,• - - _. .*. _ .4-_. � , ., ., Date Issued ------ / ______________________________________________.__ _Tltiis Permit Expires l Year From issued" "`� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County.Ordinance No. 549. JOB ADDRESS AND LOCATION___/e_k_, --------. �___=�----------- --- I L P Owners Name-------- t -------- - -- --- hope------------------- ---------------- -0 -- J. -------- e r _. -i .- .-.---- ----- ..-r----- -------- --------------------- Contractor's Name --- _ - ...` Phone..'J--- -----•. Installation will serve: Residence A artme f House' ❑ Commercial ❑ Trailer Court El Motel ❑ Other El Number of living units:._, _;:,umber of kiedrooms N_A_.. Number of baths Lot size : Elk --- Aw—_______------------------- _____ # . . `p 1 tt Water Supply: Public system ❑ �Co munity system �] 'Private'�epthT to Water Table _. �? - • � Character of soil to a depth of 3 feet: (Sand ❑ Gravel ❑ Sandy Loam -❑ Clay Loam '❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes, date_._ ) No Vjw-l�ew Construction: Yes dR-5o ❑ FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:" (No septic tank'or cesspool permitted'if public sewer is available thin 200 fee+.) 4 ? ; Septic Tank: Distance from nearest well -AM ... Distance from foundation-____ _ _. -------------- No of compartments_.__________________Size__"_-"',X-�Q"___.Liquid depth_____ �l Capacity.... �------ Disposal Field: Distance from nearest well/-4V___.Distanc'e from foundation --- ;f ,e ---- ._:'.Distance to nearest lot line__ .......... ---- -- -------'-- Length of each line- - --Q � -----•R---..�Nid#h of trench__- ` T e of filter m � _ � Z� !� is ��-- ------------------- ! Number. of lines aterial _ Depth of filter material:._.A�_�________- �otal length_____ Yp / - ' Seepage Pit: Distance to neares7m;ell__%,(-------- Distance, from foundation___ i.. D' to nearest lo# line --- _____.__ I Number of pits ' v� z : . 4 - __Lining material..,�P-G�_Size: Diamefer_�.LX��__...___ Depth--- . __.-_ - _.___ � t ` %Cesspool: Distance from -nearest Weil_________________Distance from foundation...__ -____----_:__.Lining material -------------------------------------- "m $ ❑. ° ;Size: Diameter._ -- ------ a- ----.Depth--------=----------------•-----------------------N..Liquid Capacity------- --gals. IJ Privy:" Distance from nearest well " ______________-----------------------------Distance from nrest building --------------------- 1 ❑ a _ �..,. :. � ,.w._..-� - --�-"- -�, -------------------- --------------- � rest lot. Fine-------------------------------------------- -------...---•--- -- _ , Distance to nee l;. Remodeiin and/or re airingdn besc ( e 2'r �` 3 , ._ IZ -------------------------------------------------------- --------;-- = ----- --------- s i f s 3 - ---- -- jl - - ---- ------------ ---------••-------------------- ----------------- --------------------------- I -------------------- ------------------------------- I --- -- --- - I hereby -certify that I have'pre'pared this application and that the work'will.'6e done in accordance with San Joaquin County ordinances,. State laws,'and rules and regulations of +he,San Joaquin Local Health District. l t r ,� - °r Contract(Signed) By: ---- ------ ----- - -•- Titie --- o -r -j- - (Plot plan, showing size of lot, location•of system -i r ation-to wtals,.buildings, etc.,.can be placed on reverse side). ., I-1 TMENT USE ONLY APPLICATION ACCEPTED BY-- t ► � r �r� l r� , � .� _- - �rw�U-/° TE --'s REVIEWED BY -------------- - _ tDATE_...__.-------- -----------------------• •---- BUILDING PERMIT ISSUED ---;--Z „- _-- = -- -=---=------=---------- ------ DAT ------------------------------------ -------- ------------------------------------------ - --- r 9: B T •=,,��yz�-a-pcp'�_ � ..._ , .= Alterations and/or recommendations:_ t.1t- -.-.-._--_-�_-c7�1_-r-F- ---------------�-�-:c-`--f-7-.-_fC- -1-!-Y!--�._---s—. --- --�--- --.-�-----I- ------------- -------- -- i -r _ - ------J -------Gs_ _ - _.. —r , �t -.----•-------------------------------------------------------------`.- DaFINAL INSPECTION _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 West Oak Street Y 124 Sycamore Street 205 West 9th Street Stockton, California M Lodi, California Manteca, California Tracy, California CC -9 REVIBEC B-99 F.P.CC. 2M 6.6C `. i