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FOR OFFICE USE: " APPLICATION FOR .ANITATION PERMIT Permit No. - -------- ----------------------•--------- ------------- ---- -- --------------------•--------------- -------- (CiDuplicate) upcae] f- Date Issued ---- -------------------- ------------------- � =------- Issued- is Permit Expires 1 Year From Date Iss_� 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. J I i �• JOB ADDRESS AND LOCATION. -171,-.5 1 66N_�-�-- ---------------/�C--`-----------------------------`` J Owner's Name--------------------- ---------&__0fEk_5..M6- -------------=---------------------------- Phone-------- F Address----_W21_17 1.17--------- 1. t 1 -- 13.Z©--------1A--�t�C/1�-----------------ES .1.--C.A -----........ Contractor's Name_.._.6- X1—Z� '�' ----------- ------- -- -------------------- Phone.._ ` 1 Installation will serve: Residence Apartment House ❑, 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: _�_____ Number of bedrooms :- __ Number of baths-1..... Cot size ----J4CJS4.156—�_-_ Water Supply: Public system ❑ Community system ❑. 'Private ❑ Depth to Water Tables. Character of soil to a depth of 3 feet- Sand ❑ GravellQ Sand oam ❑ Clay:,Loarri'. Clay ❑ e ❑ Hardpan 2-` Previous Application Made: (If yes,date----------- ------ } No- New Construction: Yes ❑ No FHA/VA: Yes El-:z kNo TYPE OF INSTALLATION AND SPECIFICATIONS: 3 ► _ :..-_�. No se tic Tank or cess ool` eltted"if ublic sewer i .available P � P PT�rmP Septic Tank: Distance from nearest well________________Distan, e from foundation--------------------Material __--------__-___.----- ----------.__.__-.___.. ❑ No. of compartments-------------------------Size:-_1 Liquid depth--------- ------ ------- Capacity---------------------- Nk Disposal Field: Distance from nearest well___________ _____Distance from foundation.------.__-- ---:Distance to nearest lot line-------- ❑ of lines-------------------------------- Lengthxof each line----------------------'- _---Width of trench.------------------.-.------------- Number = Type of filter material.__.._______.___".___Depth' o€Tfilter material_______________: -...Total length----.----------------------___----._______ Seepage Pit: Distance to nearest well------------.---- ____Distance from jfounclation_____________'_. .Distance to nearest lot line__._..___________ . ❑ Number of pits_ .--_-------------Lining material------- ---------- Size: Diamefd -----------------------Depth--------------------------------- Cesspool: Distance from nearest well ----------- ----Distance from foundation...............r.Liiring material_.-....._.-------..__--.-_----__._.- ^R Size: Diameter_ .. is`„RC1 ❑ Depth ---------. .Liquid Capacity------------- -------------gals. J; : Privy: Distance from nearest well_____________ __________________._....-.._.__.._Distance fJ.f lrom n crest budding.------..----------------------._.._____- ❑ Distance to nearest lot line ________________________ } Remodeling and/or repairing (describe}------- -------- --------------- - ----------------------------------- ----------------------------- A 'J4r -- PT1�._ L.. --��--- x �”- 5 -------LrAcfF-----LlN ._ -a- E _ _----- P�«:� R .. -------- --------A'P-- X----- ------------------------------------------------- 1 r I hereby of that I hav prepared•this application and that the work will be done in accordance with San with County .4ordinances, a ws, and' sandlreg "mof he San Joaquin Local Health District. (Signed)--- -- - - -- ------- _ .. ` ------............. ----------- ----- Owner and/or Contractor] Ell_ -- Y—: �. - _--------------------- --- ----- -~fes_" I -------------- `{Ttt e] - (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.-----I'-�1.R O...------ ....... ------------------------------------ DAT -3 -)77,7>l-------------- REVIEWEDBY--------------------_-- ---------- ------- ------ ------ -- ----------------- DATE-------- 4 BUIL Alterations oand/orrecommeING ndations: ------------ - -- ---DATE-------�--� _ ---------�.---- _ 1------------------------------------ l} _.-1 to ,� � l c L -----------------------•---------------•---------- ---- . -------------- •-------------- -+ --- --------------------------------------•--- ---------------- - ------------ - --- -------------- -- ----- -------- --------- ..... . . -------------- -- ----- -----•------- ------- .......... ------ - e l / FINAL INSPE ...... � . � Date...... . ....... ....7)------71- --------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California, } E.H.9 2M 1.67 Vanguard Press �; Dj