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FOR OFFICE USE �} APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------------------------------------ (Complete in Duplicate) 5 - — ... r—o r. - e-- __-m--. Date,Issued-A-,. 7-��5-• *� rThis Per.mi.t-Expires 1'Year�rom Date Issued Application is hereby made toythe San Joaquin`Local Health District fora permit to construct and install the work herein desc`ribed.' Thisapplication�is'rna2le'in`ca'rtipliartce'witli County Ordinonce'No"54'9."x'- JOB ADDRESS A LOC TION---- , �j -/llF+ i u- '�I� 41 -` - Owner's Name-- -- ---- ------ - ------- - ----------------- --------- _ -=d 4P.-hone4.16 Address. �.. . .ssfQ :- t .- .:. cw .16 r p Contractor's Name �ru r r x 'mow ----•--- Phone Installation will,serve- lResidence ❑ Apartment Houselp Commercial ❑ Trailer Court ❑ Motel ❑ Other 1Kk4&y_-1 Number of livingg unit 1 }ber of bedrooms .4- Number of baths 4---. Lotsize _�� 0-------------------------- l Water Sup ly: Public system ❑ Community system ❑ Private`K Depth to Water Table Srft. Character 6f soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe- Hardpan ❑ Previous Application Made: (If yes,dote...............L,__) No X_ New Construction: Yes ❑ -No E& FHA/VA: Yes ❑ No.R� TYPE OF INSTALLATION AND SPECIFICATIONS:,- (No'septic tank o x-.es:- pgj3pj tWitted if public:sewer is'ravailabla within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-.-------'___._...---------_..---.-----_-_--_. ❑ockvihoo. of compartments - - - - - - :---Li t uid de h------------------------.?Capacity y N --- ------ - - ----- ----Size------------------ ------.__ � I q PI I -------- ------------- Disposal Fi{ ield: ., Distance from nearest well.................Distance from foundation--------------i-----Dist ance to nearest lot line----------------- ❑6VL,S Number of lines------i----------------------------Length of each line------------------------ of trench-------------------------- - Type of filter mateRial-__- -b,pth'of filter'material --- Total length-1--------------------------------------- r� Seepage R,•st: Distance to nearestwell-- ----_--Distancepp�ffrom foundation/&....`__-..Distance to nearest lot line-�. ---... Number of its..... .Linin material. �i___�6CA< ,Size: Diameter----�J� --.De tn_-..7:�._ Cesspool: F Distance from nearest well- ---.-_.-_.Distance from foundstion---------:----------Linin-g material--------------- ----------------------- F-1 --------------'.__._______._._..._.❑ Size: Diameter. ------------- =---- ----Depth---------------------------------------------------Liquid Capacity----:-------=----------i-- gals.` -. 1. Priv Distance from nearest well--.._...._.---_------_..._...................Distance from nearest buildin t Y 9--- -------------i- -------- - ❑ Distance'to nearest lot.'line---- -1----------- -------------------------•----------------- ------------------- �l � � � a � o � tt ' Remodeling and/or repairing(describe):------ - - -- -------------•-- - - - ------�----- ii ----------------- i 1 q I ( `"-------------------------------------------------------------- -•------M------n------------------ ---------------'---------------------- I _ __ __ ----------------------------- --------------------_ _____ ordinances; tete I ws, a d rulend egulations of the San Joaquin Local Health District I hereby # I+have prepared this application and that the work will be done in aeo'dant wifh San Joaquin County (Signed) " /��.v-•.= - 5 - ---1 == _,_._"'--"__- .. (Owner and/or Contractor) gY� I.C_ 2A `.----- .------------ --------------- -- ------------------------- (Title}- - (Plot plan, showi g sill' ze of lot; location of system i relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY'° APPLICA#ION ACCEPTED I3Y� �''� -------.}.__-. r..-.------- DATE----- _ ?. .-: _-..F�[ �.-.------- _ -_ REVIEWED BY + `: --------- - - - ------------- --- ----- DATE_ - ( ------�----- -------- ----- ---- BUILDINGt PERMIT ISSUED ----- - ---- - -------- --�. . _ - DATE-- I I Alteration and/or recomriendattonsi"`. .:0.'`." _��:�..: _� -f _:__/ °^•-•� r t ""' `y"�- �!r�I c�±— -r---------,-.. - .---- y-- I, U ci .+ _^ _ I ---------- ---- I - - - �' ' ''� ;� ----------- -- -- ---------------- ------------------------ ------- ---..------ . - --------------------------------------------- ---- ----- I FINAL I SPECTION BY ---- - . .._ ----- ------� —'`--------- Date-------------- -------------- -EJ--------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t. Stockton,California Lodi,California Manteca,California Tracyr California aY r.P.CO. ] 1