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FOR OFFICE USE: ' // APPLICATION 'FOR SANITATION PERMIT Permit No. .. ,� -�a.. ------------ ------ (Complete in Duplicate) r 0 � - Date issued ------------------------------------ ,This Permit Expires 1 Year From Date Issued 04 � . `fie-- Z z— 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 compliant ith County Ordinance No. 49. ` //f��,f�_�{��•.u"�'�••{{7.24-0�4— ;--''�: e'' � OB ADDRESS AN . LOCATION 1� -------- -- -� -- ��--�- Owner's Name________ ___ __ - Phone_1j4f....�._�_`�p40______ ---- --- - ------•----- ----- , Address f -------•----- --- --------------------•• ----------------- ----- •- o 1--- - i Contractor's Name..- -''�"- Q --------- Phone ... Installation will serve: Residence ZApartment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -_ Number o -baths .�Lot size ____ _ - -_____1 Water Supply: Public system ❑ Community system_;❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Lj Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date.--:-- ........ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (N septic tank or cesspool permitted if public sewer is available within 200 feet.) + Septic ank: Distance from nearest well-__-70-----___Dista Fe fxpm f undeptipn_.__-�_� ---_�Mat 'al__...c 2z-- --._-____. ' No. of compartments_________ _--------------Siz _ _ � �a'__1 .�r_____Liquid.depth-_.." _._._._ _...__.Capacity_ :_ Dispo Field: Distance from nearest weIL:.Ifl....___-f]istan ,from foundation______ i _=._.__Distance to nearest lot Ile------------ --- -____-___ . Number of lines___:_ .Z..._. '� ___�'_Length of each line.__-__--- Width of trenc ----------_. _ -__.-" i Type;of':filter.matarial?_ t_ ____r__.__Depth.of filter,material------f_.1_-__`__._Total length_____1��_____________ ____`_.- � Seep e Pit: Distarpce to nearest well-100-1-!Distance fro oundation____1J��_. _____.Distance to nearest lotlin .__ Number, of pits------- "------ -Lining;materia .......Size: Diameter__.___ Deptn;____�Z--f_______._____ Cesspool: Distance from nearest well------------- --Distance from foundation__- _---___- . --. Lining material--------------------------------------- d ElSize,.Diameter---------------------'----------------Depth------ ----------------------------------------- ---Liquid Capacity----------------------------gals. 'rt Privy: { Distance from nearest_Wella_____________"t________--_____________.."'_._Distance_from.riearest building____________________________..:___..- ' Distanceftonearest lotline'------------1'----------------------------------------------------------------------------------------------- ------ Q Remodeling..and/or_repwr.ng (describe):---- -------------- ------------------------------------------------------------•----------------------•--------------------------------- . i ---------------------------------------------------------------i----- ---------------------------------------------------------------I------------ ---r---- --------------------------------------------- ---------------- -------------= T _-----_-------"' ------------- ---------------...--------------•--- ---------------------------------------------i ----- ----•----------------------------------- ------------------ ------------------------ :------ ------------------------------- _--------------------------------- ------- ----- - I-hereby certify that l have prepared this application and that the work will be done in.accordance with San Joaquin County ` ordinances, State Iand rules and regulations of the San Joaquin Local Health Distjidr., -------------------- --- --- ----- a on rat ----------=----------------------- Title--------------------- - - - (Signed.)--- "------------- n or or (Plot plan, showing size of lot, location of system in relation c wells, buildings, etc., can be placed on reverse side). r`] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE=D BY--------- -- -%"_ -----------•----------------------- DATE------ -- � T REVIEWED .BY------------------------- - --, DATE-------• �.. ---------- ILD.I.NG PERMIT_ISSUED-..... -`-s. I = — r DATE.----------" ------------------------ -;-- BIJ -------- Alterations andLor recommendations. /✓h' r j/ -`-��`---- ---------------------- �. _ Ld r e FINAL INSPECTION BY:........0". rN'JOAQUIN _ Date �� ' S LOCAL HEALTH DISTRICT i 1601 E.Haselton Ave. 300 West.Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Colifornia Manteca,California Tracy,California f SES 9 REVIBEO B-59 2M3-'63 F.>P.CC. Y