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~ rmit No. ArrLICATION FOR SANITATION PERMIT Pe .. ..SP_.. .5_.: - ---------------------------- ----------- ------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i st II the work herei escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION---------------R _ r---- 5-0-K__Aa-----Win---- l�i_.l_�woo-r� Owner's Name `D �` 1�� rte' -- - -- - ~ ,}. f �J �` [� Phone_._ Address-------------_---R-(-_-.-�.------/��--- 0` zJ C� l -!' --------------------------------------------------------------------------------------------- Contractor's Name.............. �Q- e��.W1-Q-.-! -___----. �/f0pi"I ,[ ------------------------------- ------ Phone----------------•-•------------ Installation will serve: Residence ❑ Apartment House ❑ Commer ['Trailer Court ❑ Motel El Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ........./T(/..-V aCre�- -- --- ------------------------------- -- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 5. . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N4Hardpan ❑ Previous Application Made: (If yes,date-------- ----.----) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No D' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public�sgwer is available within 200 fe.1t.) r Septic k: Distance from nearest w IL_ (% �}�istan t# rom if u tion.___. 4%Materia .. _.__ ._ fj to , � d �e------ No. of compartments_.._ _.-.-..�..___Size.__3 _"~ _ .___Liquid dfpth_... /___-Capacity___- �. ��i Disposal field: Distance from nearest well_0—Al Distance from foundation_/9.,4IjW.Distance to nearest lot Number of lines_-___.._./_-....1___ ______ _ _Length of each line....... _d .r_.._T--Width of trench.....------------- Type of filter material_ P _L Depth of filter material______.�.q.�.�___..Total length_..._--- fQ1J.__f_.__._.__ Seepage Pit: Distance to nearest well---...................Distance from foundation....................Distance to,nearest lot line._._._._...._._ ❑ Number of pits_____________________Lining material...._.__...._.- ----- --------------- Cesspool: ----------Cess ool: Distance from nearest well------_..........Distance from foundatonDiamet---- Lining material t--...._...___ ❑ Size: Diameter------------------ ------------------Depth..................................... ----- .. ....Liquid Capacity--------------------------gals. Privy: Distance from nearest well ..._.__..._..__.____.___........... .......::Distance from nearest building.._:`:-___._.____._______-_-_._.-... 1771 Distance - .. _. ... Distanceto nearest lot line------_------------- ------- - -----------_ -•---------------------------- --------------- - - ----- - - ---- --- ... -- _ (ll Remodeling and/or repairing (describe):..._4071,7 _o5,6& ._-_.._._ _ -._._.__. ._.._ _._. . _.� - -- -- ----•----------------------------------------------------••----------------------•--••---------•-••--•----•---------•----•----•---•-----------•---•---------- -•---------------------------•--------------- ----------- --- _ --------------------------------------- ----------- ---------------------- -----•---------------•-------•------------------------------------•----•--------- ------------------------------ ------------------ ------ -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and reg lationso f the San Joaquin Local Health District. 0 (Signed)•---- --- •- -------------- ----------------= ------------------------------------------ ----- -----(Owner and/or Contractor) By:---------------------------------------- ---....--------------- --------..------------------------------(Title).-------_-------------- --. _ --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY � APPLICATIONACCEPTED BY---------------------- --------- ---- -----------_---- -------------- ---- --- ---- - -/6D ATE------ _I-_ ...'..3 .`- REVIEWEDBY----------_-------- ---------- j-- ------ ----------------- DATE-- --------................. ---- TE AlterDat ons and/orPERMIT recommISSUED endat�ons:- f(�' tG'�/ '4/J'L�� ..;2��11 411 DA1. --.-,h�...�%:L• -�- U , (/1- -•................ . ......... . .....-... .......... .. ,/�c .... ---------------- ----•----------•----------- -•... ...... ............ ..ltd.�_ ..'(/��f rfl ---• ---------- -- F` ` -------- ....-•---•-•-------•--••------------ ---------•----------------•- •. -------------......------------------ ---•- --------- =�-' `"`=`�` ��/.✓L,.��-C �x-.: - - ------------------------ ---- -- - -- ----------------------- - ------------------------ ----- ............................................... ....... ------------------- -----------'T r u FINALINSPECTION BY-- ------------------------- ......................... Date------ ---------_-- - ------------__------- ------:--,---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 3M 3-'63 F.P.CD.