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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -' ------ {Complete in Duplicate} ; Date Issued ________________________ i This Permit Ex fres 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. 101, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__/V.'-X-r-------b..1 1 ---L -k----® --------4-$7/4. 7r` ", ,�C'` ' .. ------------------------- �+ n ` / Owner's Name---------- -�'_�__-t--�7--------------8..U--I�--�-S L-d_-C-H------------ - - - ------------------------ ------------- Phone--f. Address---------------------- —5-1-4------- .- .� f� i1V ------------------------ Contractor's Name---------------------------�-A---1{� -�_SZ -� ......------1- -I--------- ----- •--r--------------- -- Phone fi - - Installation'-will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 19 00 { Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ___- _ r Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table _747 ft. � Character ofrsoil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe ❑ HardpabA Previous Application Made: (If yes,date--------_-----------) No K New CoF.nstruction: Yes. ' No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic lank: Distance from nearest we11M491VAEDistanc from ndatin d� M {No. of compartments__.___ ____._SizeALiquidepth--.--'S1.3 ---------C a pacity + p Field: Distance from nearest well_/�p1L�l�Distance from foundation_- . �_ `- Distance to nearest of Number of lines_- ______Length of each line_ "' _ ic{th of trench_______ _� t_ __._1 i Disposal 9 � �Q - N' ~-''-- T_y,pe of filter maferial__ (Q -----Depth of filter material... --- .t-____.___Totai - - l length_-- a � 1--____.-�__ _-..___ 'xf f ` Distance -- Distance to nearest 1ot`le4�SeeP 5e Pit: 1NA Distance 1 - � ' pth- � Number of pts ------------ -- I. gm � : ameter--! ----- ----------- ------ Cesspool: --Cess ool: well t Distance from nearest well __ _ _._.__Disfance rfoatnLinininater *? _...___._ F-1 _____________ Size: Diameter--------------------------ir.........-De Depth .�! uid Ca acit S,.Li p _ �q P Y gals. Privy: Distance from nearest wel3._-._.i_._.____._.L_+1 "_ Distance fronea est buil 'n� ____ _____-__.__ l__ ._ ❑ Distance to nearest lot line______ ________ .' ,i . F �-- ft Remodeling and/or repairing (describe):_. _:_.�►_ ___:______ _ `Y-- - _ L_____ - ��f 1. x � w f _________________________________________________________________________________________________________---_______-____.___.___.._______I--•------_ ------------------------------ ------.--_ ____-._.--. __- -----------_-- b I I hereby certify that I have prepared this application and that the work willbe done in accordanceewith San Joaquin County ordinances; State es and regulations of the San Joaquin Local Health�bistrict. W 1 {Signed} ------ ---- .- R_ - - Owner and/or Contractor) t Title ' - __ By=�'------------------------ ----•--C F---- -- --- - ------ ---- -( } A� ---------.--.......------ ------ (Piot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be place- FOR DEPARTMENT QSE ONLY , APPLICATION ACCEPTED BY. f/` ��' i E'R DATE__._ t 4---r---------------- ,- - „ . F , REVIEWED BY �-41I 1----•-_. DATE--.-._ _--------"--------------------------------------- J �, BUILDING PERMIT ISSUED.------------------ --------------------------------=-------------- f- — - DA'.E---- ---------------- Alterations and/or recommendations:.__�'L 2______-_ --------------- ----- -----: _--------.--- -,7- 2----- ------------------- .--+---<�------------'- -_ L = -- ----------------------- -• ---_ ________________________________ _ter------..---_.___ _- _...._._.__.._-.-______- __...._______ -------------- ___'. ......... ___.__-._._._...__.__...__.___---__—...._A______- i F FINAL INSPECTION BY:--------- --------------- ----- Date------------------------------------------ ------------------------------------ y SAN JOAQUIN 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