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FOR OFFICE USE: ----------- ------------- �1 f r --------------•-�___- -< --• �- APPLICATION FOR SANITATION PERMIT Permit No. .1_._/--�'�___ ------------------ ------------------------------------ (Complete in'' buplicate) Date Issued __ ' _/4-r --------------------------------------------------------- This Permit Expires I Year From Date Issued ZVQS_ Z � 9 Application is hereby made to the San Joaquin Local Health District for a peri In f to construct and install the work herein described�� This application is made in complia a ith County Ordinance No. 54.9. JO 'VDRESS AND LOCATION. Ctl2- � __ 3 . � - 4r�- A-V ----- -- ---- --A Owner's Name ° = RRA[ 4�- �0j hone----- -- Address------- >n.:- -. �^ _ .c ! . ----------- ---- Contractor's' Name-------- ----------- -•-��R.( tJ..-�-.--------751 Phone �Gr � �lP-�•-1 Installation will serve: { Residence ❑1 Apartment House ❑ Commercial ❑ Trailer Court ❑ oottell q Ofhtr (� �"Oj Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------- .. ___ �_______________ Water Supply: Public system Oz Community system El 'ivateDepth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: {If yes,date------- ...._ -----I No X, New Construction: Yes ❑ NA FHA/VA: Yes ❑ NOX '1 _ TYPE OF INSTALLATION"AND SPECIFICATIONS: _- � _ N -•. __ -�=-.r. _�- ��, (No septic tank 4 cesspool permitted if public sewer is a`vailaWe within 200 feet.) it Septic Tank: Distance from nearest well-----------------Distance from foundation_________ _________Material_ --------------------------------------------- El ________________ ________..__-- _.__.. No. of compartments---------- ---------------Size.............---- -.------------Liuid deF.th___._._____.._.. - Capacity is o al Field: Distance.fro'm nearest well__��_--.-Distance from.foitndation_f�__-_�_.�::--bistan�ce'to nearest lot line_"----..__. Number of lines_________-�'`_ :_ Length'of each line___gC�_��_�_{�___-__.Width of 4=1 Number T e of filter material . _De th of filter material___: _ �' Total length r A YP P 9 �� 5 Seepa a Pit: Distance to.nearest we4__1,0Q__------Distance' f o foundation__1Q_6______-Distance to nearest lot line__._.--_.. Number of pits---�—________.Lining materiaI__ _ _kSize: Diamete------ Depth....... _____________ Cesspool: s Distance from nearest well-________________Distance from,foundation__--___.____.______.Lining material----- ❑ Size: Diameter----- ------------ ---------- --i Depth-------------- =------------------------------------Liquid Capacity---------------------------gals. (O Privy: Distance from 'nearest well-------_--------------------------------------------Distance from nearest building---------------------------------- ---- -- ID Distance to nearest lot line'_____________________ l '•-------------------------------------------------------------------------------------- ---- ---- � t Remodeling an /,or repairing (describe):-- _� -- --------------[- ---------- )<-- -- 1-/� ------ _- -- ------- -_ •/�l� -•------------------------------------------• -----------------=-----------------------------------`---------------------------- --------------- --- ----------------------------------------- U ---------------------"-•------------------------- ----------------- -y ------------------ ----------------------------------------------------------------•--------------------------------------`---•--------------------------------------------------------------------------- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,IState laws, and rules and regulations of the San Joaquin Local Health District. 15 44e I f0 A42(Signed)----------------------------- -------?r, �I`5 - and/or Contractor) T v wn 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------K_-/ REVIEWEDBY-------------------------- --- ------------ - ---- ---------- ----- -------------------------------------- DATE---------------- ------------ ----------------------------- P BUILDING PERMIT ISSUED------------------ -------------------------------------- --•-f-------------------------- ---------.. DATE------------------------------------------------ Alterations and/or recommendations:--------ria/_T�......... -_- ._____7--42--------- Q_©- ----------------------------------------- --------------------------------- - ------------------------------------------------------------------------------------------------------------- -------------------------------- ------------------------------------------------------------------------------------ -------------------------- ----------------------------------------------------- ---- -- ----- --------------=-------------------------------------------------------------------------------------- FINAL INSPECTI N BY: Date------- ........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.