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FOR OFFICE USE: AllA,---.-----r------.---C,^f"-------- -- --- UU d , r- _�`-_' _, APPLICATION FOR SANITATION PERMIT Permit No. ._-f __ ----------------------=----------------- (Complete in Duplicate) - [ p P ) Data Issued ---L'd1__-(.� -------------- -------_----- ---------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local.Heal+h District for a permit to construct and install the work hewn dgscrbed. i This application is made in compliance with,;Cou'nN Ordinance No. 549. I JOB ADDRESS AND LOCATIO.N-_ ;_2_'.W-tA1 , JAW-- -------------- Y Owner'se---------- + A--- -----------------I---------------------------------- - -.------------------------ ----------- Phone-------------------•--------------- Address -� - ------ ------ ------------------=------- jj. --- ---------------------- --- - = .------------------- -----------------------•---------------------- ----- 41:Z 75 Contractor's Name ,"-j_. �• R1 -al J 1 1�-�.� Phone Installation will serve: Residence artment Nouse ❑ Cammpbrcial [j Trailer Court;❑,Motel ❑ Other ❑ Number of living}units:1/--.._ Number-of bedrooms-_ Number of fhs _A�ot size ----------------------------------------------------------- - ..- 1- t Water Supply: Public system 0 Community system ❑ Private Depth,to Water Table --__-�t. Character of soil to a depth, of3 feet: Sand E] Gravel 0-"-)Sandy Loam ❑' Clay Loam ❑ Clay E] Adobe ardpan 11Previous Application Maddi .•-(if.yes,dater�--- ------------) No.,[] New Construction: Yes No ❑ FHA/VA: Yes [�- No ❑ �. J -w�- TYPE..OF INSTALLATION�AND'SPECIFICATIONS: • tt (No septic tank or cesspool permied if public sewer is available within 200 feet.) ;,A w } :`' ;" i 1 - " ..� Z ®� .Material--�----- Septic Ta Distance from-.nearest ell_f �_--_Distance fromoundation________-- r No.of compartments- --_.-____--Size__- Liquid depth- �{��'-._ Capacity- ` 9710-- Disposal Fi Distance from nea'rreest, well_�0Q_-_-Distance from foundation---l�-.---.---Distance to nearest lot line----- Number of lines-.14------ __-- ,_-Length of each Iiof tre ne_f��-�---- `�oidth nth nch-__ y�_--___=--'- i Type of filter material-•�a4 t Depth of filter material-_� °� g ,r---------Distance from foundation-- . Seepage � Distance to nearest welL�,'�,�,1_-_- � `_-� _ Distant�� nearest lot line/--�_----_ Number of pits._.-.-----._---Lining materiaL_�Q_G}>�--.--Size: Diameter. --.- -Depth_. _:--_-____-__--. Pj Cesspool: Distance from nearest welE- ------------Distance from'foundation--------,--------__.Lining materiaL_._-----_---_-----_--------__-__--. � , ❑ Size: Diameter--------------------------------------Depth---------------------------- - -Li uid Ca aci ----- els. - . Distance from nearest building - ---- DOWPrivy: _ Distance.from nearest well--- ------------------ ------------------ - g---------- - --------------- --- ❑ Distance to nearest lot line------ ------------------------------------- ---------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----------------r-- --- ---------------------------------------------------------------------- ---------------`-------------------------- I ----------------------- -------•----------------------- �# } _--------_----_---._-___-------------------___.-------_---._.------_____-__._...___--------__--.-_._____-__.._.___-_______...._-_--_-.. - ------------------------------__----..--.__- __----__•_------___--------_-----__-__---__••__•__-----____:»..---_---_-_-_-------_------_----•_-•------------------------__------_-__-_----------"-._.___-----.-___._-.--.-.- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the.San Joaquill Local Health District. r� (Signed)_ o t �=. y Contractor) - --- ,�,,.- tie)- --- - (Plot plan, showing size of lot, location of system in relation to Is, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.- DATE ` �/ REVIEWED BY---------- ............. -------. -�---- --- -------------------------------- ---------------------------------------------- DATE-----------------.---------------------------------------- BU I LDI NG PERMIT ISSUED.-------•---- i DATE ---------- - Alterations and/or recommendation s:--.-gyp/ � I . -------------- -------------------------- -------------------------------------------•--------------•------------------------------------------------------- r --------------------- -------- ---------------- - Dat .� ... I FINAL INSPECTION�BY: -' -` ---------------- --------------- Date ------------ - -";"V" 0/.---------------- ------------------- 5q . ,�,� .� k�. '•�..�� S- 5 � �Y� _. ?may. • SAN JOAQUIN'LOCAL HEALTH'DIS'RICT 1601 E.Maielton Ave. 300 West Oak Street 124 Sycamore Street y205 West 9th StreetR Stockton,California Lodi,California a� ` Manteca,California Tracy,California CS 9 REVISED 6-59 3M 3-'63 F.P.0 D. f