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-- v ll- ----- ---... - ------------" f '_ICATION FOR SANITATION PER Permit No. .a2.9.... _. _'' - - - . ...... .. (Complete-in Duplicate) Date Issued &__:2. ..�7 - - ... 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. ,q3,41 JOB ADDRESS AND LOCAT N. Jt� - (,�-- -- -- -- - -------- ----- .... .__S. Phone-----------------.............. Owner's Name- Address..---------- - Contractor's Name------ ---- --- Jit vt = .`�- -------------- Phon4011kh�P47T---.... Installation will serve: Residence Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -------- Number of baths-------- Lot size - --........... ..... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 70 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 0- New Construction: YesjK No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_0ff ,`7..._Distance from foundation..!�_.'--_.Material.- ...... (X No. of compartments--_CZ).__._. Size-4.)CZA-5--------Liquid depth .....-. Capacity.l2E1014i Disposal Field: Distance from nearest well.Ak Distance from foundation.. 5..a............Distance to nearest lot line------------ . Number of lines_S------ .._._. _.-....Length of each line_60--l. . . Width of trench._�¢1-_f-_ . ._...._. d rr . ... cJ Type of filter material-------- ___' ,._-Depth of filter material__L.I.-....--...Total length._1_..d._.Q_...L' F_ i Seepage Pit: Distance to nearest well_AJQ/U15—.Distance/ om undation./Q.(._.....Distance to nearest lot line.c�1'._1........ Y$ Number of prFs._ .-_-_____Lining material_([ ... Size: Diameter.... 3"r__-_.Depth__ .. ...._--_..._--._. Cesspool: Distance from nearest well --------- ---- from foundation ---_ ---- _ _Lining material-----------.--- -----_------__--- ❑ Size: Diameter. .. __._- __ _..._....-----Depth--- Liquid Capacity .___..gals. Privy: Distance from nearest well Distance from nearest building-------------------------- Distance _Distance to nearest lo+ lin Remodeling and/or repairing (describe): .. _,lL.(J._._ __.. .. --_----C1/-----------_-_--- ---_--- ---- --_.- -----------...-----------`----------------------9--__..-------------------------------------..------------------------ ----------------------------------------------- I herebyy certify th a prepared this applicati and the+ +he work will be done in accordance with San Joaquin County ordinances, Sfa}e law , and r es and uta+ions oft San Joa uin Local Health Disfrict. (Signed) - - -...telaffion - (Owner and/or Contractor) By: ---- -- .(Plot plan, showing ze of lot, location of sysfem to wells, buildings, etc., can be plat on reverse side). ��y� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bim/ . ................_.._.___ DATE-.I. :_ .-.-.ay?._...--_---__ REVIEWEDBY----------------------------------------------------- -------- - - - --- - --------------------------- ------ DATE. ..------------------------------------------------- BUILDINGPERMIT ISSUED--------.....-----------------------_---------:--- ----- - -- - ------------ DATE. -.. --------- --------- -__..._. - -------- Alterations and/or recommendations:----------- ---- - - --------.. .------------------------------------------------------------------------------ ----- --- - - --------------------- ------ ------- _ -- -- -- ---------- ------------I---- ------ ----- -- ----------- - -1---------------------------------------- /- FINAL INSPECTION BY:.. _ y Date..l _r_�. _— _ _- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoteliers Ave. 300 West Oak Street 120 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.92M 1.67 Vangvord Pros