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V-0 ` 1 f , ('--------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. ....._-_-------- ---- (Complete in L.Nlicate) Date Issued -._ -.a 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. t. This application is made in compliance with County Ordinance No. s , � ' -----�-- --5-49. :..r. JOB ADDRESS AND 1 ----- -- ----- 1100 Owner's Name---- ..........-.1�Ca�/ /1'il'7_C/rA/•'.._J�„i 0 e r Address �3 =f� 1.._••--• y��f__C ''1` > 1>l _. Contractor's Name----------- r�Ci;'r 'I .. -- .. ----••----•-----------------------•----•-- ----------t-----. Phone..,5-_--/.k/-.Y 0'-,7.. ~ Installation will serve:- Residence ❑ Npartment House ❑ Commercial ® Trailer Cort ❑ 'Motel ❑ Other ❑ Number of livingunits: _-_:.-- Nu - '� GS -.- }ger of bedrooms -_.__.. Number of baths -_______ Lot ize ---__:_��>.4�_�'_./:..r`�'._� -. r,. Water Supply: Public system J0 Community system ❑ Private ❑ Depth to Water Table ---------- ft..::- Character of soil to a�depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loo.rnjx Clay.-F] Adobe a Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes R'No ❑ FHA/VA: Yes ❑- No 5j we TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer is available within 206`feet) Septic Tank: ,Distance from nearest well_..-'- _-- 's.ance from found tion _._f____.Material-.Tf'%!------------------- r. [ No. of compartments......!?Z"--_--___..._. ize .�_...L+id depth----��__._-__--__.Capacity_f��--._�j�, Disposal Field: Distance from nearest well--_-�....Distance from foundatiorrt -_ j si IT (.J�_--'ir__.Di tante to nearest lot Number of lines___-_�____� --------------- ength of each line--/Q .'.:_-�__r_-___.Width of trench.--,- ____------_--_.._ Type of;ilter mate rial__-±-�p4 ✓___ epth of filter material-- :_-_._____TojaQVngth......�- -c-!2---------------------- Seepage Pit: Distanc4ito nearest well-----�----------Distance fr m foundation(../��/.-_-.Dista'�ce to nearest lot line._..-•�__�..- Number'tf pits--__ ...........Lining terial__- __Size:tbiameter_-'4F�� ; `{_Depth-----a --------------- Cesspool: Distance from nearest well-----------------)bistance from foundation(I LirlWoatenal._.-_--____.-_______-•_--•-_-_-•--.--. ❑ S,ze: Diameter. epth.- ---- ---------B--------------- Li id Capacity----------------------------gals. Privy: Distance from nearest well --..-..--___..'----------- _ p.......Distande from nearest building-----------------------------._--_-__.-. ❑ Distance to nearest lot line - '-----------------•---------------------- ---- sl � ` a � � s.. � V Remodeling and/or repairing (describe) // / ?---------------- ,255.._ .....�--------------=---------------.......------------------------•------- r ( `�--- - ---------------------------------------------------------------------------•----------- ----' ----------•------------------------- I hereby certify that I have prepared this applicatio and that the work will ie done in accordance with San Joaquin County ordinances, State laws, a ules and regulations of the San Joaquin Local Health District. (Signed) .�- % O ner and/or Contractor) y-, �t ron By:-------------------v-n-- ---- '7 s.�s-u -----------•-•----- ---'------,__---..------(T'itle)Plot Ian, showing size of lot, ocation of ystem in rection to wells, buildings, etc., can 6e placereefse side). l P �. 111MFOg D PARTMENT USE ONLY APPLICATION ACCEPTED BY.......Y4l -------- ------ _- .- ------ DATE_..._l.� _._� -._--- - -_ REVIEWED BY-------------•-- --------------------------- ------ ------------ ----------------------...-• --- --- -- - - ---.-.-;.---.:•�. DTE? BUILDING PERMIT ISSUED--------------------------------=----------------/-----------------------r--------+- ------------ ATE ------------------------,------........................ Alterations and/or recommendations:----_-.- -- -?- -- --b_---�.--- ----F � -= -�r��--------�` '� � V ....... •-•••••. ... a-s'------`--- � " �1-- ---- l�-----------•---- - ----ti ---------------------------4---------•---••----- - ------------------------------------------------ WNW L� — ------• Date------�........y r, FINAL INSPECTION BY------ ---------- ---------rN7 --------------- �----------'----------------•------------------------- SAQUIN LOCAL HEALTH DISTRICT �. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California