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_IUKOFFICE USE: ;t _ ..a_-.._� -._--: � �_ APPLICATION FOR SANITATION PERMIT Permit No. .r1�Q .1 ----- ----''r-------------------------------------- - (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _ — � Cot 6&0 -1/,, 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 CATION.--.._ -_ ../_ 1' iy� -•--_�-- ""'j]/liy 1,1A14w5W_/t- Owner's Name--_ --------- ------------------------- -------------- Phone------------------- Address--------------- -----------------Address. i rcQf4� - ---------------- ----------------------_-- ------------------------- Contractor's Name . ------ �..i`.L�S!` ------C�--- _ �,. - ¢�1/ Phone..6Ap.0— Installation will serve: Residence ❑ Apartment Housef ❑ Commercial E] Trailer Court [] Motel ❑ Other ®' Number of living units: _..I_. Numbertof,bedrooms -.-'4Number of baths.-L Lo+ size .-..--,tel 4.(�'. __---------------- Water Supply: Public system ❑ CommunTity system ❑ Privat g Depth to Wate Ta61e f�ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam 5 Clay E] Adobe E] Ha pan ❑ Previous Application Made: (If yes,date--------------------) 'No New Construction. Yes E] No ® FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt__..J -Distance fromfoundation--- __..-..Material.. G',FJ ---------- op rr -------Liquid depth____,"_"'_-.-----Capacity_,' Disposal Field: Distance fromnear } weli.. --.'.-Distance -Distance from foundation.-.�,0-_ ...Distance to nearest lot ® Number of lines...--. _____ _ +_ _Length of each line,_$$_- _-Width of ___----.--- T e of filter material__-�,'G +�.Depth -------- Type of filter material--- ____-__._Total length_____-. ____ Seepage Pit: Di stance to nearest well_14249-----!Distance��f� foundation71Zl---------.Distance to nearest lot line-_^-;----------- MA Cesspool: Distance from nearest well"-":_ _�.,'mDistanlce�fr��undation Diameter.___..��_ ma},pepth__ __'_______-___ ® Number of pits-------- _,-.--Linin Lining erial------------------------- ❑ Size: Diameter----It------ ---------- Depth - --------- --- Liquid Capacity--------------------------gals. x Privy: Distance fro1w nearest well------------------------------------------------- Distance from nearest building----__-....--.-----------._-.-..---------. • ❑ Distance to nearest lotPlir�e --- ------------- ------- --------- --------- I A. , Remodeling and/or repairing (de''scri e):____.�1/s ------ ,T _ ° --------------- I � . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of t e 5 aquir Cocal Health District. I y (Signed) - 1 -----------y 01 ------- ----�------------ wne and/ar Contractor) BY: ------------------- (Title) -- -- ---- -------- (Plot plan, showing size of lot, Iota+' t of system in relation to wells, buildings, etc., can be placed on reverse side). r .. FOR DEPARTMENT USE ONLY �t APPLICATION ACCEPTED BY do� .--------/— REVIEWED BY. ---------------------------------------------- DATE BUILDING PERMIT ISSUED...................... .. t-� -- -- DATE Alterations and/or recommends+ions:_#.___. �_.._ :.�__�_. . �c._G ):: L� ------ z�- � ..�,ti aCs�.c z (s �. -- -- ---- = -tet c� -v FINAL INSP�TION BY:.-...`_- >.-...--- ---•- 'L- Date r C- C G SAN JOAQU I N LOCAL HEALTH DISTRICT ,��c �•--� �/~� +�7�� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California s,w l