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FOR OFFICE USE: _ --------- �7 t. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...l�:J 7._7 (Complete in Duplicate) This Permit Expires I_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 ANQ-LOCATION. tvI�-�_X"ment. -!Y T_._ 3---- 2-- �J(�! '�E-` ! __.- j_- '� ---- Owner's Name--------VT........2-S, �►7: B1.5------ 4� P/-... � - Phone = I ' Address................. // ,Q Contractor's Name---------------- 40'P 4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: _- --.!Number of bedrooms _3--- Number of baths - --_ Lot size ---------------------- i Water Supply: Public system [A-- Community system ❑ Private ❑ ,Depth to Water Table _X0_ 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--------------------) No [ ' New Construction: Yes [A-- No ❑ FHA/VA: Yes E] No F TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Not of compartments well----------------Distance from foundation._/O._.r_.__Material_._ _ _Sr°- P ' � --Li' ui � -- ------------ LK P Size-�l1X,$�. - = 9��P#h.-_D`��ce to Capacity OO!, Disposal Field: Distance from nearest well-.___-------Distance from foundation.. .-. .._:_...... tt nearest lot line_. ---- le --- Number of lines-------- .-------_-Length of each-line----7. —___.�d� j Width of trerich.{?- ---`� ---------------- Type of filter material-------------------------Depth of filter material----------.- ---.---Total length--:'--------------------------------------- r— I _ - pp 41 See it: Distance to nearest well __..."`--._.-_D'sstance fr Ff ndation---Q_S------ Dist a to nearest I iine_ _.� Number of pits'_.-_ Lining material--s- .Size: Diameter__._ .. ----.------Deptn__.— _._ ---__ / e Cesspool: Distance fromi earest well-----------------Distance from foundation_._._.__ ---....Lining material__ -------------._.___._.-..----l --. Size: Qiameter- Depth �❑ - ---- ----- -------------------------�------------ --------Liquid Capacity-... __ga Privy: Distance from nearest well........................................ .......Distance from nearest building------- ......---------------.--.--.----. ❑ Distance to nea'rest-lof line-----------------------------------------------------------------l ------------------------------------ ------------------------------ O �/ t Remodeling and/or repairing -(describe: __AX --------- .. t w-- 1 I ------------------------------ ------------- --------------------------------------------------------------=------------------------------------------------------------------------- t I -- I hereby certif that-[-have piepared this application and that +he work will be done in accordance with San Joaquin County ordinances, a aws, a d rules and regulations of the San Joaquin Local Health District. j I k [Signed /-S ^� 9 )------------------ - f 11------ ------- --------------------------------- [O er and/or Contrda%rJ By:---- ---- •---- �Iioctafi J =------------------------------------------------------------(Title)--- l I (Plot plan, showing size of systemin relation to welts, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY M APPLICATION ACCEPTED BY-- -------- ----------------------- ---------------------------------------- DATE- `- ��` REVIEWEDBY--------------------------------------------------- -------- ------------------------------------------------------- DATE-------------------•--------------------------------------- BUILDINGPERMIT ISSUED----------------------- ------------------------- ------------------------------------------------ DATE-------------------------------------------------------------- Alterations and/or recommendations:./:7:/"-3----(-,5 C'v ..... 0"&:�r� rc... __.../✓r. __..�rl�� ------------ ---------- r-- � .` �27---- � C,vza ---- - s 9------------------------------------------- --- ------------------------ ---------------- ------ ----------- ---------------------------------- --------------------------------------------------------------------------------------------------------------- --------------------------------- ----------------------------------------- ------------------------------------------------------------------- ------ ----- ------------------- ------------------•---I-------•--- -------- - ----------------------- 1 FINAL INSPECTION Date_./= ._.� �f. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktan,California l Lodi,California Manteca,California Tracy,California m