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FOR OFFICE USE: , F - -- ------------ -------- Jv. APPLICATION FOR SANITATION PERMIT Permit No. �2 ` ---;---- ---------- - ----- ------ (ComplMe-fin,-1�yplicate) --- -------------------- - --. This Permit Expires 1 Year From Date Issued Date 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 LOCATION2l 5 _ � 'p---- Z�------------------------------------------------------•--- -------------- --- Owner's Name. ►�►�;= " ._ _17GFCv---••-----•--------- - Address - -----_ rPhone,_ t -----� _ Contractor's Name-------,Sc'l�_.-------------- --------------------- Phone-.:--- •---•------- --- Installation will serve: Residence 0 partment House ❑ Commercial ❑ Trailer: Court ElMotel ❑ Other ❑ Number of living units: -1.... Number of bedrooms >�_.- Number of baths-------- Lot size ---- _-_�� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Cay ❑ Adobe [ rdpan C Previous Application Made: (If yes,date---------------- ] No ©— New Construction: Yes E3—No ❑ FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: ( . (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) Septic Tnk: Distance from nearest well__! _'___Distance from foundation_ 10......_..Materia-l._-_-.-.-_-.-6-- p -reA1-__ No. of compartments-------- ------- - Sr___-.-c_7._-_.- - � _ -( , Liquid epth----- py----- DisposalField: Distance from nearest well Q'..._Distance from foundation-__-- --------Distance to nearest lot line_-.__rfJ�_.. Number of lines__.--.__3______ ___,_�_l___ j Length of each line_- ----r -------------- Width of trench__.-.-_ --�_'!__-.--------__ Type of filter materia d[ _--Depth of filter material-.__-/�_......-__-Total length---- - �-------------------- Seepage Pit: Distance to nearest well------- -------------Distance from foundation------------------- Distance fo nearest lot line---------------- 1 ❑ Number of pits Lining material. ----- - Size: Diameter--------- -------------Depth---"------------------- --------Cesspool- Distance from nearest well _____________ Distance from foundation----------------- _Lining material----------- ---------------- .__. r ❑ Size: Diameter- ----- ..... . .........Depth---------- --- --------------------------------------Liquid Capacity-.------------------------------ ---pa __------- --.--- - is. Privy: Distance from nearest well _._ -Distance from nearest building ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):..._ --- yw j ----------------••---------•----------------- -- ---------------------- --- - ------------------------ - ----------------------------- e - _ • ------ ---- �,,v� - I hereby certifyat I have prepared this application and that the work will be don In accordance with an aquin ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. (Signed). ---------------------------- -.._(Owner and/or Contractor)" /y By-------------------------------- ' 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 -------- --------------------- DATE-------cf— __`G..7 ------- EVIEWED $Y - ---------------- -- -------------------------------- - - ------- -- DATE_-- BUILDING PERMIT ISSUED-------- -- - ------------- --------- DATE--- Alterations and/or recortimenda+ions........... .......... . . _ r �� • _____.___ .._ S-P -�_�L{✓_.._.._-__�_-__-.�"G%._""'r' ...-_` .....1... _ lam'.�•L _.._ _�'.�"-----' •.-� -------..........---------------------------------- ----------- _ - 5-71SI -� -�_....-- ..._.._ M� -1 _ �• ��-- FINAL INSPECTION BY:............. ------------- --------ear»----- Dafen..- :.� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfa:ellon Ave. 300 West Oak Street 124 Sycamore street • 20.5 West 9th Street Stockton,California Lodi. California Manteca,California i .. Tracy,California E.H.9 2M 1-67 Vanguard Press