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FOR OFFICE USE: '. -------------------=----------------------- - APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- ...1...73L_- ------- -- ----------- ------------------ --------------- (Complete in Duplicate) Date Issued �ft�_.6y.___ ---_------_--------------------_....-__---_-.._..-,.; This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit tb constru_ct'arid install the work herein described. This application is pm de in compliance with County Ordinance No. 549. , 7SC— JOB ADDRESS D LOCA ION AIV-- - ------�--1�F - C�----[:JI-OTTI . Owner's Name 1 Ql�l� � �T '------ ---------,-,,----f---------- --------Address-....... .T - ------ Q K--------155-2-------------- L��-V---- ----- -------------------------------------------- Phone---------------------------------.. Contractor's Name-------------- �_�.�. ---•------------- -------------------------- -- ii Installation will serve: Res.ider0j� `Apartment House E] Commercial E] Trailer' Court ❑ Motel ❑ Other E]Number of living units:' 1 _._ Number ofb.edrooms -3-- Number of baths _ Lot size _�___ _______R-CR��-'------------------ f{ Community s Stem Private De th to Water Table�?eft. Water Supply: Public system,?❑ C y y _ ❑ � p r Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ��1a y E] Adobe❑ Hardpan a- i _Previous Application Made.: (If..-yes,.date_.__,..-- _)=„No,�New Construction: Yes 2�o E] FHA/VA: Yes ❑ No Q TYPE OF INSTALLATION AND SPECIFICATIONS: Se tic Tank: p Distance fpom npearest well:_-�� _ --Distance from within 200 feet.) r No septic tank or cess ool permitted if public sewer is avail p om foundation_____-I�-----...Matenal-_- I� p �1�rf)C_ iquiddepth__ .:-----Capacity��-- ---f�----- y No, of co� artments��s'._._._�-�--�-';.�S.ie___ ...___ � 1 .r Disposal Field: Distance from nearest well...SO----.Disfance from foundation_m_:Q ___--..Distance to nearest lot line.._____._____ � _� Width of french--- ____ /! Number of lines------------/ ------------Length-,of each line- ------ --- �X I Sir�� ` T-- - v� AP10 Type of filter material-_. Q._G Depth of filter material___ _.__._____-go al length_____._________ __. --------------- Seepage Pit: Distance to;.nearest weli__00---__--Distance from foundation___ tante to nearest lot line..._~ ��-•-----.Dia l/� ----•----- Linin materEal- t __.Size: Diameter. x__ _ _ _ Depth ': D stance from nearest well __.___g_.__Distance from foundation------------------- Lining p ---� ------ 1 ' ---------------- Cesspool rng material------------ - ----------------•- ❑ Size: Diameter---- ------- ------------------ Depth------------- ------------ - Liquid Capacity gals. Privy: Distance from nearest well ________________________-----____.---------!--Distance from nea�e� building----------------------------------------- ❑ Distance to nearest lot lire- -------------------------- ---------------- ------------------------- ------ -------------------------------------------------------- Remodeling and/or repairin (describe) ---------------------------------- -- ---------------------------------!-- ---------------•----------------------------------------- , ------------- G?-------- �L C�------0� _ �,,� - ---------------------------------------------------------------- ------ i € ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- -------------------------- - I hereby certify that 1 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 Joaquin Local Health District. A. _ -. - _ l _. Owner and/or.Contractor. - m _.-(Signed)--------__.. -- ----------------------------------------. :-.. �-�----- , . �---��. ---._ �--,...�� -soya. B ------------------------------------------- Title --__----------------------- -----------y, Y=-- ------ ------------ � (Title 1 � (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -J t-R,_0!-.-....... ---------------------------------------- DATE C��-� --� ------------------ REVIEWEDBY--------------------------------------------------- -------------- ---------------------------------------------------------- DATE----- - --------------------- --------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- ------------------------------------------••--------------------------------------•--•---------------I---------------------------------------- ...�_- --------- -------------=----- -~�-------- - ---------------_----------------------- —F _ µ ----------- ..�.,,. . �. ....K .M _ - -------- --------------------------------------- RnFINAL INSPECTION Date-------- -- ------------------------------------- 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 F.P.0 C. we m' - w