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JOR OFFICE'USE: -------------------------- ------------------------------ ------- --------------- -------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- ---------------------------------- -=---------- (Complete in Duplicate) ------- ----------------- --- --- I------------- This Permit Expires 1 Year From Date Issued Date Issued �2-S 7- 2-7-0-/4, Application is hereby made to the Son Joaquin Local Health District for a permit to construct and instal] the work herein described. This application is made in compliance with County Ordinance No. 549. 1 111`1 PC, JOB f1DDRESS AND CATIO ----mon F > -- ----- ------- --- -M---- --- -- -- ----- -- - ---* - - -----F - ------M,-r ------- ----------- Owner's Name------------do --------------lftq � .�X?mQ--------- --- --- ------------- ---------------- ------------- Phone------------------------------------ Address-----------P)-T-F--- Contractor's Name--- ----6WN1F_ Z; --------------------------------------------------------------------------------------------- ---------------- Phone------------- ' Installation hone-------------- Installation will serve: Residence Apartment House ❑ Commercial El Trailer Court E] Motel El Other El Number of living units: _-_f_-- Number of bedrooms �-_ Number of baths ---I--- Lot size' Water Supply: Public system El Community system [] Private Elbepfh to Wafer Table /2-- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam 2r--Clay Loam 0 Clay E] Adobe 0 Hardpan C] Previous Application Made: (If yes,date______- - ---------I No , New Construction: Yes [c --n"a E] FHA/VA: Yes E] No TYPE.OF( INSTALLATION AND SPECIFICATIONS: i _;ko No septic tank fa - 'r cesspool permitted if public sewer is available within 200e-e-f.) Septic Tank: Distance from nearest ----Dish e from foundation__-_/ -.-.-- .. No. of compartments------~L ------------ Liquid depth-- --------Capacity-,17,q P :y Disposal Field: Distance from nearest wefi__.;.�_ -----Distance from foundation---.-/ ........Distance to nearest lot line----------------- Number of lines--------i------------------------Length of each line----------7�...........Width of trench.-.---__ �� Type of filter material---RO-C�- -----Depth of filter material--__. Tofal length------------- ---------------- Seepage Pit: Distance to nearest well-.-.___-----__-_--- Distance from foundation------ *-----------Distance to nearest lot line------_---t----_- 31 El Number of pits---------------------Lining material----------------------Size: Diameter-----------------------Depth-----_---------------------------- (10 Cesspool: Distance from nearest well-----------------Distance from foundation---_--_____--- . Lining material..._-__-_._------- -------------------- ❑ S'fze: Diameter------------------------------------�Depth_--------------------------------------- ID -----------Liquid Capacity-- ---------------- ------gals. Privy: Distance from nearest well----------------------------------------- Distance from nearest building----------------------------------------- I El Distance to nearest lot lire-.. ------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------ ----------------------------------------------------- ----------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- - ---------------------------------------------------------------------------------------------------------- ------------------------------------------ ---------------------------------------------------- ----------- -------- ----------------------------- ---------------------- -------------- ----------------------------------------------------------------------------------------------------------------------------------------------- I hereby c fy that I have prepared this application and Prpf the work will be done in accordance with San Joaquin County cAI. ordinances, S at laws, anjd_5ules and regul on fh an quin Local Health District. - ------ - ---------- (Signed) - - ---- -- ----- --- ---- --- ..... -----------------------------------------------------------------(Owner and/or Contractor)- ------------- ------------------------- -- - -------------- ----------------------------------------------(Title)- h wi g S, ------- ------------ - -------- -(Plot an, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - --- ------------------------------------------------------------ DATE_----------- REVIEWED BY------- ----- --- ----- �---------- ------------------- -------------------- --- ------------------------------------------------------------------ DATE ---- ------------------------ ----------- BUILDING PERMIT ISSUED-------•----------------------- ---------------------------------------- DATE -------- Alterations and/or recommendations: - ----------- ----- -------�c&7......7-S__Ro------------ --------------------------•- 7 ----- -------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------- --------------------- ----------------------------------- ------------------------------------ -- ---------------- 7------- .... --- ---------- --- ------------------------------------------------------ ------------------------ -------------- --------------- -------------------------------_... .... . .... . ----------- --------------------------------- ------------------- ---------------------- --------------------------- FINAL INSPECTIGN-By-•---- ----------------- Date-------------------- KCA" --- -- ----------------------------- i' 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.00.