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f O.R=OF,OFICE USE: i Permit No. �••r ��•- ------- ----------- ----------- ----- ---------------- � APPLICATION FOR SANITATION PERMIT -------------- .................. --- ----- ------------------..._----__-_-_-_..- ---.._ (Complete-in Duplicate} ._._ ------------ Data Issued _--- __ This This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. r JOB ADDRESS AND LOCATION .�� t3� 7 �417ZCI�� ---- f �y coo' . �� '�® Owner;5, Name/ -----------------------. '�:__._ �i�_ 1�- -Y A��i----CPSZ-�----- Phone C' �%,P!3✓_ •------------------------------------------- Address k� f Contractor's Name----- , j1, .�,t11C�_-. �- . TC .-------- Phonet - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: __f__ Number of bedrooms__ Number of baths./____ Lot size -�®---a-,�. ... ----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __� ft Character of soil to a depth of 3 feet- Sand [Gravel E] Sandy Loam L] Clay Loam [:1 Clay E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------_l ..No —No New Construct,on: Yes:]_No FHA/VA: Yes ❑• v�TYPE OF•INSTALLATION=AND,-S-PEC-IFIC-ATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well. . -__....._Dis}anc� from fouy�d�tion________________ __�M/ae �f No. of ,compartments- 1;Z_..____-_--___ __....Size9' -3----_-_-Liquid depth.-T- ------ --------Capacity-, -- ----• .. Disposal Field: Distance from nearest well-trQ---------Distance from foundation_/___._...Distance to nearest lo/t,Ir� -._..__.__ Number of lines__.----I{-�-----y-►---,--�-- --- Length of each.line_&C, __----------- of trench-_-a2 ---------------------- Type of filter materiaY �' 4-�ll Depth of filfier material--t�..._.._____Total length../P6___ ____________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line__.___-_..__.._ � ❑ Number of pits.-- ------------------Lining material---------------------- Size: Diameter.------------------.--Depth--------------------------------- Cesspool: Distancte from nearest well ________________Distance from foundation..._............. ..Lining' material.----_.-----------.--.--------.----- Li uid Ca acit ' ❑ Size: Diameter- -- ---- ------- ----Depth-------------------------------------------- q p y--------- gals. Privy: Distance from nearest well---------.--------.--------.-------- ........__.Distance from nearest building----------------------.___________--_-._. ❑ Distance to nearest lot line_- -------------- - -- -------------------------------------------------------------------- - Remodeling d/or r pairing (describe):. Y --------- �----- "/� f. .P1.-- _. '1.�. __ems------I_—.$__:_ /�?4 ---------------------------------------------------- -----•------------------------------------------------------------------------------------ -- ----- ----------------- ------------ ------- -- ----------------------- -----------------•----------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned ,x� ' l�7 - -- - l an / r Contract ] p. . : -- ---•-- --- - - {T itle o - f'I ' locatio o s s em i rn elation�"#o IEs buildings, etcbe plac ., can ed on reverse (Plot plan, showing size e . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- "" r -� -------------- DATE-------�:tnYP-fir ----- REVIEWED BY------------------------------- -- -- ---------------------------------------•------------- DATE - - ' BUILDING PERMIT ISSUED-------- -- - -------------------------------- ---------•---------------•--- - DATE :- -- ---------------------- k Alterations and/or recommendations=----- ---------------- ----- ---------- ------ ----------------------------' ----------- ----------- - ----.--------------••------------- ----- -- ------------------------- -- ------ -- ------ --------------- -LL ------------------------------------------------- --- ------ --- f-------- -------------------------------------------------------------- ---- - --------- - --- ---------------------- ----- _ __ ---- - ---- -- --- - - - - -. - -------------- ----- ------ --- ---------- ------ -- --- ------------------•--- -- -- _. . _. -------------- l FINAL 'INSPECTI BY:... Date- .... � Y-7/ --.---6-e------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. ColiFornia Manteca,California Tracy,California l E.H.92M 1.67 Vanguard Preis ,,