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FORK OFFIJ USE: °. ----------- Permit No. -. ..-�JA -------------------- -------------- ----- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued Z1-5_q-q- "$'f[-EKG✓ - ."`t' This Permit Expires 1 Year From Date IssuedZ Zrr_ be Application is hereby made to the San Joaquin Local Health"Dist rict fora permit to construct and install the work herei ed. This application is made in compliance with County Ordinance No. 549. C 1 JOB ADDRESS AND LO TIO --- ------ .. -----��an17A-��-�---�.�--------- ----••- '-�----- -- -----f��=---- ----- Owner's Name f �`� C {? L�. �---------------- -------- ---------------------- - Phone_ _ Address I Q_ y�'� -��_NI_��_�----� -----------9 1 of Contractor's Name-/419 T. Cfl- 5 !7?L"_SIV_!Gh ----------------------------------- -----k:r _ OX 623_._: Fio^ne Installation will serve: Residence'I�Apa�i'ment#House ❑"Com ercial ❑�'RTrailer Court El ElOther ElNumber'of living units: _F1'-`Number.of bedrooms _" -__%Number of baths _2-__ Lot size'____ G � *:i Water Supply: Publ.ic'systemk❑ Communitylsystem ❑"fL,Priviate ❑ Depth to Water Table _ ____ ft. I f soil to a de th of 3 feet: Sand Gravel E] Sandy Loam El Clay Loam ElClay-❑ dobe [-]j Ha Character o prdpan ❑ Previous Application Made: (If yes,date.................._) No [ New Construction: Yeso'❑ FHA/VA: Yes ❑ No �..:. Xt m TYPE`0E-INSTALLATION"AND 'SPECIFICATIONS: - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Y Septic T.nk: Distance from nearest well__-?`—r ____-Distance from foundation---__14_._"" _.Material__C01VR ------- ;,� . �k, of compartments------- �-- ------Size-- A'jj2X SLiquid depth_-_ ^"-r -Caps itY-- --- •-- _ . ares C J} Disposal'Field: Distance from nearest well..._.) 4?--_,Distance from foundation__�gQ--------Distance to ma st lot line___ ___._Len Length of each line__.___ _[/ Width of trench____-.... ..G'•-- � � Number of lines---------_._ g ?r- . Olt - ----- Type of filter material" �p`C- _ P sem - Total tohnfearest lot ' --K____"De th of filter material___ �_� 9 Seepage Pit: Distance to nearest well ____5Q_---_-_Distancekfrom foundation____/Q.__.__Distance line--.---__- Number of pits_""_� Lining materi l_ ize: Diameter__B� ---Depth-------- ---- �-- ICE Cesspool: Distance from nearest well----------------=Dis ce rom un atlon__ _.__..fining material_._._ - ----------------------- #'+ -----gals. ❑ Size: Diameter--------------------------- ._:.Depth------------------------- Liquid Capacity_'_`_ . ' ------.--_Distan e'�fr6m'nearest,building--------,;-------------------------- Privy: Distance from nearest well; .t __"--------------- ❑ �------------------------------------- -_-$"' 1----------•- -1 4.4 Distance to nearest lot line---__---- ---- ---"----;;;-�;-------•------- -- Remodeling Remodeling and/or repairing (describe) -----"--...------- -------------------------- -------------- --------------------------------- -- ---------------#------------------. -- - __r. :. -------- - ---------------------------------•- ----------- -----"------------------"------------------------------ ----------------------- ----------------------------------------------------------!---------------------------- ----------------------------1- 1------------------------ ----- I hereby certifyjk'a5 I have prepared this application anclAat.the work wiil-be-done,in accordance with San Joaquin County ordinances, Sta e,ldws;and rules and regul tions aof the San Joaquin Local Healt+�h,District. s E ------------------------------ (Ow Contractor) -- St ned _ .�..:.�� - ----------- :- :: .: .:� �--:� } . ane - (. 9. ],;^:* Title or B -. ---------- ------ - Y� ------------------ - ------ - - ------ ----------f-- -- (Plot plan, showing size of lot, location of system i relation to we11s, buildings, etc., can b placed on reverse fide]. FOR DEPARTMENT,USE-ONLY .. APPLICATION ACCEPTED BY- f------- �� -------------- -4- --------------------------------------- DATE ----- 2 -- ------------------- ► REVIEWED BY--------------------------------------------- ----- -- rl t &!�A� j 31 DATE- BUILDING PERMIT ISSUED=_. ._:__.. y.==_ __.__:_:- -- .,__:.._-_ -:::_:__ DATE . � _r_r1 -r, ---- ------------------------------------ ---------------- ----- ------------------------------------------------------------- Alterations and or recommendations .______.__,_____________ i .w.a r ll d.i,i'1 t &A_, 1 1 !'_ k ��--------•-------- - - --------------- ----------------------------- ---------- ------------•---------------------------------------------- ---------- - ' ------------------------------------------- ------- ---- ---------- - ---"- 1 ---------------------- -------------- ------------------- ------------- --------- --------------------------- --------------- i ECT1B � � Date-- -------------- --------------------- FINAL INSPSAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-•63 F.P.CC- ate'' `