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----FOR OFFICE USE:, --- ----- f ____-.___--------- APPLICATION FOR SANITATION PERMIT Permit No. ..-2,,,2 _=_ . (Complete in Duplicate) ._ - This Permit Expires 1 Year From Date Issued Date Issued __�1�__ls .___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i made in complia a with County Ordinance No. 549. M'T -19 -- t � rr r JOB ADDRESS AND LOCATE __ Owner's Name kJ ~ g `- 'OIL -------'-;-A 4A �T. 'n T _j A ? -� - Phone------------------------------------ Address------------------ � ----------- �-------------w -1T ------------------------------------------------------==--------•-_-------- Contractor's Name----&W4 RL -•------------------------------------------------------------------ --•--- Phone-----------.-----------•--------•- ' Installation will serve: .Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ ��Motel ❑ Other Water Supply: Public system Community system PriNumber of baths------ Lot size -----_�:1CRE_A-��_______________________ , Number of living units: ___._-__ Number of bedrooms --=___: pp Y• Y ❑ Y Y ❑ va:tdf DDepWto Water Table _------- ft.4 Character of soil to a depth of 3 fee+: Sand Gravel ❑ Sand oem ❑1 Clay Loam E] } ,Clay F] Adobe E] Hardpan E]Previous Application Made: (If yes,date-------------,._-_-_-) No New,Construction: Yes [.j�-�o ❑ FHA/VA: Yes ❑ No { TYPE ,OF INSTALLATION AND SPECIFICATIONS-.j '� �• ' {No septic tank or cesspool permtttedTif public sewer is available witKini200 feet}, ' -- i ! x i Septic nk: Distance from nearest well-J?- Distance from foundation _- I__.yMaterial__<_a�CAa.T�______________ t No. of compartments_._�...............Size-_ X_�57----Liquid depth----./-/�-------_Capacity... ©0---.--. Number of lines__________ _ _ _ ______________---Length of each line__3.O---- --- --.Width of trench._____. -e _ 'r Disposal Field: Distance from nearest well__ _____ Distancefrom foundation_______-__ _ 0�_...__.Distance to nearest lot line___ I g . -ii t �` -Total length --`- -•--- Type of fi{ter material--R0CK____De Depth of,filte'�.ma#er�al__J1_�_______:.__ g ''C�___. Y p - p L �..r.� �...,,.� V... . . Seepage Pit: Distance to nearest ell___ _______-_ Distance from foundatonf___�o__ Di Lance to nearest lot'li ____ _ Number of pit's--------- __-.------Lin ing'matenal__ Q_ f�-.Size: Diameter__._ __.....K.._...Depth-----� ------------------- Cesspool: Distance from nearest well----------_______Distance from fo Aa atron_._._..___._.------.Lining material _--...-_-___-.____.______.__-______ ❑ Size: Diameter - ------ Depth-------------------------------------------,--------Liquid Capacity- ------------------ ------gals. Privy: Distance from nearest well-----------------------------------------'i....Distance from nearest building---._____.._____..___-______________._.,. ❑ Distance to nearest lot line---------------------- - 1---- ----------------- ----------------------------------------------------------------------------- N V 4 Remodeling and/or repairing (describe)=-----------------------------------------------�_----------- •---------------------- -----------=------------------------------------------ } `---------------------------------------------- 1 certify that',.}iav prepared +his application and that the work will be done in accordance with San Joaquin County ordi antes, to I s, nil s and regulations of'theYSan'rJoaquin Local Health District. {Signe -�1-------------------------- ------- -- --------------- ----------------------------------------------------------------- ------(Owner and/or Contractor) ---- -- - - liy:--•------ ----------•-------;---------- -------------- ------------=----------- -- -------------------------- {Title}-�,-------- ----`- - -._.......... . ----- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on'reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- F�.--- ----- --- ----------------------------------------------------- DATE___ .<. ,3 _- i - ------ REVIEWEDBY-----------------------------------------------_ ----- -------- - ----------------------------------------------------- DATE. r''�------------------------------------------ --- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE---±------------ ------------- ---------------------------- Alterations and/or recommendations--- ------ -----------------------------------------------------------------------------------•-------•------------------------•----- --- ------------------------- - --- - - -------------- - ---------------------------------- --------------------------- ------------- FINAL iNSPEC ------ - r Date------------- -- � - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California A - Manteca,California Tracy,California .- ��. r.P.co. -