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FOR OFFICE USE: ---------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------ -- -------- --------- ---------- - - -------- (Complete.in Duplicate) °Date Issued . _J_-�.�` ---------------------------I - g This Permit Expires 1 Year From 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. { i . J08 ADDRESS AND LOCATION 77 2--- � -'` -- -- - ------------------------------ :n — -.-�-*. Owner's Name----- - = .. lt- ---------------•-------------------------- -------=--------- ------�--w - Phone--4-4.4--- Address �a � ° -- - - Phone---- --- ---- i Address-------------------•_..._(._5 PI"'wv G�.. ' - ---------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------ � � - } ----•-------•---------------•----------------------------------- ---- ---------------- Phone-•-• '�'----•- t Installation will serve: Residence Apartment-House ❑ Commercial- E] Trailer "Court ❑, Motel ❑ Other ❑ � Number of living units: _)____ Number of bedrooms .!!---.`Number of baths -4-11-of 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 ❑ Clay ❑ Adobe ] Hardpan ❑ i ? {- • . : A Previous Application Made: (If yes,date___-__"_-_--__--__) .No [k New Construction: Yes ❑ No [� FHA/VA: Yes F] No � r TYPE OF INSTALLATION AND SPECIFICATIONS: T / (No septic tank or cesspool'permitted if public sewer-is available within 200 feet.) Septic Tank: Distance from Fl- nearest well _ Distance from foundation___________ _______.Material-_-___--_________--______--________._----_-_-___. No. of com artments--------------------------Size--------------------:-----------Liquid de th-------------------------.Capacity Disposal Field: Distance from nearest weir-fJOVS_.Distance from foundation-----,,5------ '----- Distance to nearest lot line----, --------- ' CoINumber of-dines-".'__________ -------------------�Length of each line------`.,�5...---------.....Width of trench----------}�--.-4----------------- Type -- ----Type of filter maferial___ f#filter material_____ _ _________Total length------.------------.__-�____-_-___ Seepage Pit: Distance to nearest'well----------------------Distanceffrom foundation_-_.,........-------Distance to nearest lot line__-__-_________-_ N ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------€............Depth-_------------------------------- t Cesspool: Distance from nearest well----------------- from foundation---------------------Lining material____________________________________ t ❑ Size: Diameter{-------------------- - Depth_----------------'---------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from*nearest well---------------"----------------------------------Distance.from nearest,building----------------------------------------- LA ❑, Distance to nearest lot line------------- r------------------------- ------------------------------------------=------------------------------------------ -------------3 Remodeling,and/or-repairing (describe):----&Aj.---+-- e..X-i—A-1X,- ----- 5��-�-1�_.... 1.__l�_S-S------L-5-----�f�T-------n------------ u -----i-,5.......0-o<-`.A-- -1--2-1Q 4' C--4 -" ----------------•------ --'-------------------------------------------- ---- I, t Q =---------------------•-------- ---------------------••----------------------------------------------------- -------------------•------------------------------------ r I hereby certify that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. ($i ned 9 )--- - •PC-It- - - • ---•---- -- --- ----------- ------ - -: - -------------•------------------------------- ----------'------- .(Owner and/or Contractor) B _C.4'1n,n_�.*+. ;---•--- tz �a----•-------------- - ---------._ ------ ------- Y�----- ----- _ - - - ---------------(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--�-_ ---- --�� --------- - ------- ------- • REVIEWED BY-------------=--------------- ' --_----- --------------------------------------- ------------------------------------------ DATE--'----------- -- BUILDING PERMIT ISSUED-_--------I--------I--------------------------------- ------- -=----------------------------------- D'ATE. �, - ------------ -- -------- --- Alterations and/or recommendations:--- ` l �11 -�r �... 2 ... f ----------- I ----------------- -------'i--i ---------- -------------------------------------------------------------------------------------------------------:----------------`-------------------------------- - --------- `------------------------ r - F I t" - �{ FINAL INSPECTION BY:-----�� - - ------ -?— ----------- Date...4/--G__ �.//----- SAN JOAQUIN LOCAL HEALTH DISTRICT 2 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i� Stocklon,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-$9 3M 3-•63 F.F"CC. i 1�