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FOR OFFICE USE: - -........................... --------I..........- ............................................._----- APPLICATION FOR SANITATION PERMIT) Permit No. 2 - a__5 ... ........................... ............................ (Complete in Duplicate) Date Issued .. .... ..................... 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 compliances with County Ordinance No. 549. JOB ADDRESS AND�LQIrATION_G�i _ ... 2/ _?--cy�� iveiPsrprj. r,f-_.s!_ /%P�±'s%e-�-4: Owner's Name -----J_�pG(il..$�� 1 ----- .C��1.ri!v—-�.1iP�l�-G. -----------••---- Phone._••tA_,.4 t¢p Y.----- Address -- — r---�i- ZIT.►' -- G �/G------._ —... - ---------•---_--_-_---------------.-..- -:= Contractor's Name........ 1 :,�.CS-f .._a - ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Q"Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___'.. Number of bedrooms Number of baths _!" Lot size ---_--- .GeP<i4l G'._.._.--_-_-- Wafer Supply: Public system ❑ Community system ❑ Private [a--Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EF- Clay Loam ❑ Clay ❑ Adobe❑ Hardpan 0/ Previous Application Made: (If yes,dote----__......._.) No D-'�New Construction: Yes ❑ No er�FHA/VA: Yes ❑ No S— 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.................Distance from foundation----------------Material......_....................__................ ❑ No. of compartments.---------------_.-_Size----------_-..-Liquid depth-------_...............Capacity-_._.::_._._._ / Disposal field: Distance from nearest wall...�Q._..._Dlstence from foundation/......__..Distance to nearest lot line..._...--...._. 21 Number of lines.___./...... ............._Length of each line..�l?O_ T____Width of trench-__ .��,. _{....._...... \ Type of filter material_`/ �iL -..Depth of filter material.Lc "..........Total length... L?o- -------------_..... Seepage Pit: Distance to nearest well-!L'�.�_.....Distance frpm foundation// .___Distance to nearest lot line....?fl....... 011 Number of pits._-..../............Lining material.:s.�r.,r><.__..Size: Diamefer_.Y1r.......-._.Depth------ ............... Cesspool: Distance from nearest well.................Distance from foundation..........._.......Lining material_.................. ............ ❑ Size: Diameter......................_............. Privy: Distance from nearest well........_............................__.Distance from nearest building---.__....-_.._...._;...___............. Distance to nearest lot line------•---.....-------•-------------.........-•--------•---•--------• --••--------_...---- ,f/i i Remodeling and/or repairing (describe):.......f::.L_- _.___..- !..... ... ..................-.....................-------- --....................... - -------------------------------------- .-..-.-. I hereby certify that I have prepared this application a d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rWwa and regulations of the Sal Joaquin Local Health District. (Signed).-------------------- - J --------------"--------- ---` / -----------.--I---`----- - w r and/or.Contractor) . BY:— - -— — ............_-------- (Plot plan, showing size Ofm ;i--;w,-Fin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . ,rj APPLICATION ACCEPTED BY_4210.Y1',-11 ,C.-yr---------- DATE.Q.: .p_.rl ............................... REVIEWED BY--------W.&__..------...-----------_- —..— - - — ._.- DATE ii H"L` t `"- -••••- .— ---- BUILDING PERMIT ISSUED.-----------_...................._-__. ...... DA-TE._----._--.--_. '. -- - __ - - -- - - --- - -- --. Alterations and or�ecommen afions�-------------------------------- -•-----� � .-:-._.----:.:.-_..--.-- -.. --—` --- ------------------------------ -------- -- ------------ --•-•----_------------ - y---------- -- _._.__.•.——— - -- _-. FINAL INSPECTIONBY_jI?-r1 1t t�'�1 .. --_----_ Date...7-_�Z-/� - . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Stockton, California Lodi, California Manteca, California Tracy, California G.a.cm