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FOROFFICE.USE: 4..; ------------------------------------------------------- - rt' ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._.�� _ ---------------------------------------- --- --- ------- (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 ' stall the ork herein described. This application is made in compliance with County Ordinance No 4912 �y � E7sc"91- 3 JOB ADDRESS AND L CATfOI�' S/AiE.. E1111�-------2 -,= ------- Owner's -- Owner's Name- QRl"} -_._..�i.4 SO_�.�•------------_---------- ---------- ------------------------- Phone------------------------------------ Address-----_----•--21-30----------- 59 L I-F0-R_mA 4 V.F--------------- C/9 L Contractor's Name-----CW-N-1� { '+wr. .' Plione�+ . ....................... Installation will serve: Residence &-Apartment House ❑ Commercial ❑ Trailer Court ❑ M6tel ❑ Other ElNumber of living units: _ --- Number of bedrooms -3_ Number of baths/rLLot size __________ ___/9C.R ._____._________.__.._____ Water Supply: Publicsystem ❑ Community system E] Private �Depth� ' Water Tablecl7 of Character of soil tr depth of 3 feet: Sand ❑ Gravel ❑ S dy Lo�' Clay Loam �aay ❑ Adobe ❑ Har pan PF Previous Application;Via e: (if yes,date--------------------) No /New Construction: Yes VT- No ❑ FHA/VA: Yes Nr TYPE OF INSTALLATION AND SPECIFICATIONS: ` {No septic� kO. or cesspool permitted if public sewer is available within 200 feet.) p /t.. ndation--- ------ ter aI..C..I— . Septic ic: flistance from nearest well --.___Dista j�� --------- N -----_- Cho of compartmentss'�_, ...... --------Size-' � O# - _:.__Liquid depth___ ; ------Capacity._-_ Disposal Field: Dis#a rtffrafn�nea e t we :.74 D arc from fouun�detio UO-_--___.Distance to nearest lot lire-.-7------- AN ember o Ines ._- ----�- .LenIV !gth of each line-��'>}4-Z-�------Width of trench---_y2��.................. Tjype of.Cter mate ria l--�{O_G}�._.__Depth of filter material---- ____i' Total lengfh�------7v---- _--------__.----.-- Seepage Pit: D' __ "" r; _Linin 5materince from foundation.___ ____ Distance to :nearest lot line_..` Distance to nearest well _______Dist - ... Number of pits. .....-- :. g ' aI__. �_�� S'ize:�[3iameter-�X--�------Depth---.le--=-�-2----- Cesspool: Distance from nearest well-----------------Distance from foundation------------- -_- Lining material---_.--__-.._.----_----._____---._-- ❑ Size: Diameter --�---------------- -----------Depth ._%ft !�_1% ----- Li uid Capacify 6 � �.� � � ---��- - �--- q P Y- - ----------------------gals. Privy: Distance from nearest well---..__` «! _- -_-Distance from nearest buildin g - ❑ Distance to nearest lot line--------------- -------I- ----------------------- �-- Remodeling and/or repairing (describe-------------- ----------------- --- ----- •------------------- ---------------- -----------•------ - ----------------------------------- ------------------------- I-------------------------------------------- ------------------------- - ----------------------------- ------------------------------------ ------------------------------------------------------- 1 ----------------------------------------•-----------------------=---------- 0-----------------------------�- - ---------------------------------------------- 1 hereby ceAt y tl at I have prepared this application and that titer .ork will be done in accordance with San Joaquin County ordinances, State laws,-ra-nd rules and regulations of the San Joaquin Loca14rHealth District. L - (Signed)-------•----------- ---- = ------------------- n and/or Contractor) B ._..-._� ---------------------------- (Plot _-- Y' -... {Title----- --------------------- (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION AAEPTED BY l l -Q'- ---- - ------ ------------------------------------------------ DATE------- REVIEWED BY.----- - ---------------------- ------- DATE__ BUILDING-rPERMI.T__ISSUED= = - ==== =- }.z == =--=------------------------•-•--- .............. --DATE........ Alterations and%or recommendations:- --- ----- ----------- ------------------------------- ---------------------------------- •------ --------- ----------- ----------------------- ---------------------------•• ----------- ------------------------------- y" `- `� -,- .. . . --------------------- ---------------•--------- .war ri gw N Ili 34,::++iii i ---------- ----------------------------------------------- --------------------------------------------------------------- ----=---------- •---------------- ---------- FINAL INSPECTI Date------..... - --� ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F-F-x a. °'t