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vlb �OR OFFICE USE: ..M4.2........................ --------- ...... ----- APPLICATION FOR SANITATION PERMIT Permit No. ....................... � (Complete in Duplicate) - - -. 3 "�d--------------------------- This Permit Expires 1 Year From Date issued Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and instaflfhe work herein described. This application is made compliance with County Ordinance No. S49. jar Vir../�J_ ..7rie i�� e,4,S 7- _5 JOB ADDRESS AND LOCATION---9 w ------------------- ...... Owner's Name.......^ -------ZrAVA------------- ....... V--- ------------------------------------------------------------------------------------- Phone...__...._.---.____...__..._.__.._. Address------------)!- 4:75 57--o-e-1& ". rp-v-------------------------------------------------- Contractor's Name..-0041 ,erP, Obi r?. -------—_4 ----- Phon.__:ql�. ._-.........60. Installation will serve: Residence 0 Apartment House E] Commercial E] Trailer Court D Motel Ej Other ' Number of living units: !7Tt-r. - Number of bedrooms Number of baths -- Lot size ----r-4R-.q Wafe r Supply: Public system E] Community system E] Private X Depth to Water Table ........ ff. Character of soil to a depth of 3 feet: Sand [I Gravel F] Sandy Loam E] Clay Loam JZ Clay [-] Adobe E] Hardpan Cj Previous Application Made: (If yes,date . .. ......) No ;4 New Construction: Yes X No E] FHA/VA: Yes Ej No 7 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/ ,. 7',-Distance from foundation-..,30...r77' Material---- No. of compartments......oL..............Size--- Liquid clepth..... .... .Ca acit ...50.0 Disposal Field: Distance from nearest well-ZPP_,Fl-Distance from foundation----- to nearest lot line_________________ Number of fines..___...-___ .____ __ _________Length of each line....... of trench.___ .7s. .......... Type of filter material. Depth of filter material-----1Y-----------Total length____..__- Seepal - ----------- ge Pit: Distance to nearest welI__./1A/0_A7j-.D1stance from foundation...r.$-frf_Distance to nearest lot 112e............ RNumber of pits ..../......... ...Lining mafer1aIX0__T?eC-k,-...Size: Diamefer_._.__,3__a 'r -Z -S Cesspool: Distance from nearest well.................Distance from foundation............. ---------Depth-----o... ....... ------- ElSize: Diameter.......................... ...........Depth........................................... . ...._L 1 ining material....__...._._........................ L'quid Capacity............................gals. Privy: Distance from nearest well................_...............................Distance from nearest building-_..__._...__._....________._..._......... 0 Distance to nearest [of line Remodeling and/or repairing (describe):-----7--144.5-------- _)_5-----_A---5_4!,P),j_c........ ...roY__42...................... off-.14. ........4aASA......0ALSitiv--------- ..................................................................................................................................................... ------------------------- -------_---------- --------------- ------------------------------------------------------------------------------------------------- ------------------------------------_................ I[hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordina I nces. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) (Owner and/or Contractor) .... 7 jP - I - -------!��- -----------------__- - ----- ----------- .. ..............................I------ BY:-------ez__ �.. _ .. (r,+Ie) (Plot p;Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP A >RTMIENT USE ONLY APPLICATION ACCEPTED 8Y.___.._.._(�7ffj!0' ........... DATE REVIEWED BY,.-.. W. -------------- . ......................... BUILDING PERMIT ISSUED........ ...... ----*------- ---*---- ----------- -------**------------ ........ ........ DATE---••.......................•-••- ............................................................ D)T E.;/ .............................................. Alterations and/or recommendations:.-:. ..........I.... ......................... ............. ................................................... ..................... ....... ..............................................1........................... ..................................-•-•--.....---•.............•---........ ......... ....................................................................................................................................... ........... ................................................................ ..............................................................................I............................................................ ...................... ........................................... ... . .......... ............................................................ .................................................................... -,7 FINAL INSPECTION BY:--------FK------- ....... . Date........- ell SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Hairelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California Fco,