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+ ruiC urrlC,t USt: -x`-41 ---- - --- - ---- --.P1 APPLICATION FOR SANITATION PERMIT Permit Na. __/.-.y 3f-•-- (Complete in Duplicate) ------- -- --------- This Permit Ex fires 1 Year From Date Issued Date Issued ___ h{ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein zThis application is made in compliance..,with County Ordinance No. 549. described. - — OS7 - Ivo r JOB=ADDRESS AND.LOCA-TION` ��f� . � qG � �ZI7 • Owner's Name.----------- --r--.J-•.-•-�- -•-- ---'�-� %� ----- ---�,�� --------5._� ? - ------ ------------------done--------------------•-------- Address--------------------- -•----/4 �z � ------- Contractor's Name 1� �5�_ 0---------------------•------ ---------------------------•------------------ --- AQ, I.es' J ..�✓!/ --------------------------------------- Phone - Installation will serve: Residence ❑ Apartment House P ❑' Commercial Lg�Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths __. Lot size -__ ':;j��p i Wafer Supply: Public system'.❑ Community system ❑ Private EB-.-6epth to Water Table 40_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam i y ❑ Y E3-'Clay ❑ Adobe ❑ Hardpan [] } Previous Application Made: (If yes,date__________________ _) No [� New Construction: Yes ❑ No [-4 FNA/VA: Yes ❑ No TYPEOFOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from--nearest well___ d---Distance from foundation_ ---------------Material__ r {�� ,�O No. of compartments---- - Size-� � ------ ------------ ----------------------- �4 A 9� '----Liquid de`th_..�'" .'---.._.Capacity-e-,," /. Disposal field: Distance from nearest we1f. ------ ----------- Number --------- Distance from;foundationQ---" Distance to nearest lot line__------�- Number of lines---------- Len th of each line_ 1� g ----_t _._.Width of trench__ �_-_�____ Type of filter material___�fe/ .--Depth of-filter material I ` Tota! length- f-�- ._�.., Seepag Pit: Distance to nearest welt__" � .-/Distance fro foundation____ r ` y____._.Distancq.)o nearest lot line.._ ""----- Number of pits--------- ____--_Lining material___/ Size-Size: Diameter__ = Depth_..�s`"___�----------- Cesspool: Distance from nearest well----------_......Distance from foundation------ ------------- Lining material_.-__-._.__-_.__________._"______.._ ❑ Size: Diameter - D.epth ------- ---------------------Liquid Capacity-------------------------- gals. Privy: Distance from nearest well ________""_" -___.--__Distance from nearest building ---- g----- -------------------------------- ❑ Distance to nearest lot line_____ ______ -------------------------- ---------------------------------------------------------------------------------r------ Remode --------- Remodeling and/or repairing (describe):__.____ G[�__ - / --------------------------------- -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- _ A.. . --------------------------------------------------------------------- ------------------------- ---- --------------------------- -- ify that I have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certe ordinances, State laws, and rules and-regulations of the San Joaquin Local Health District. (Signed)---------------------------� _ _ - --------- t.� D -- /. ------------ ---------- ner d/(?r Contractor) BY: -------------- - ------(Title)-- R a (Plot plan, showing si of lot, locafior system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... - ----- -- DATE �_ REVIEWED BY: ------ ---- ----- DATE ILDING PERMIT ISSUED-"--_-- --- [ ------------------------ --------- -------- ----------- ----------- +--------------------- DATE Alterations and/or recommends#ions: r " I� �_ C �""" ^/� c �"fi ,._ rY _ x . I ------------- ------ ---------------------- ---------------------- ----------------------------- - --------------------------------------------------------------- FINAL ---------- ---FINAL INSPECTION BY:.... lam( --------- -- �� ---- Date---- ---- C/--�- .. S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 3 0 West Oak Street i24 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,Corifornia - , I Tracy,California F.P.0 4.