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_µ FOR OFFICE USE: -� __2--------------------------------- ____ _________ APPLICATION FOR SANITATION PERMIT Permit No. ...�fP_ v _,T3 (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 install the work herein described. This application is made in compliance with County Ordinance No. 549. MW47EC19, JOB ADDRESS AND LOCATIO -----•--��------�-�------ ---�-- _�'��,-'-----'--��------yy-��-�-t--A�=----------kM------------- Owner's Name-_------------- r>� '11N,,41W t - -•- ----- ---j�-�--'----------------------------------------------------- -------------- --- ----- -- -------- - - Phone--------------------------------•--- Address------- � ` � � � Contractor's Name----�_�-�(�1L:---•�-�-�---••-��------/.vlj'��►��---'-----�•-----------•---------•---._....-•---------•--••--•---•--------•-•- •-----------------•--------------------- -------------------- Phone-•------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Goer# Motel ❑ Other ❑ Number of living units: _!.____ Number of bedrooms ._ F___ Number ofrbafh`s _ Lot size _____1XV_._.AA� -_ e�r_--__-.__ Water Supply: Public system ❑ Community sy em Private ❑ Depthito Water Tablel. ft. Character of soil to a depth of 3 feet: Sandre Gravel [❑ Sandy Loam?❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date________ __________) No�INe Construction: Yes 2,,N E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer sa ailable within 200 feet.) =_ n Septic Trak: Distance from nearest wel ,.?....______Distance fr m foundation__ _____._.__. WaeL_r�-��1-✓Q��$No. of�compa tments__ __ ...__�-_ ze_3X_X_,�____.-Liquid depth__1_ ��____._Capacity_..__. _&�_____...i-1N Disposal Field: Distanc from,nearest well_,.�___._._.._:�Distance from foundation---,0__ ___�Disfance to nearest lot line_ ------------ 3 __ J __ ____ E �Number of lines. _ ___Lthof each line -460 otrench.____.____ _ j-- ---------- Type of filter material_RO��__Depth offlter,matenal�! �___________Total r� length___-__----6-p-------------------- Y Seepage Pit: )Distance to nedrest�we�l-----__---------------Distance from foundation--------------------Distance to nearest lot line----------------- T- El Number of pits !" "'" ---------Lining material-----------------------Size: Diameter__-E------------------Depth---------.----------------------- 0 3 Cesspool: Distance from nearest well_________________Distance from foundation---------...---------Lining material---.------.--------------------------- ❑ Sizer biameter--------------------------------------Depth------------------------------- -- ----------------Liquid Capacity_------------------------..gals. Privy: Distance from nearest well-------------------------------------------------Distance .from nearest building------------------------.------ __-_..-. y ❑ Oiistence to nearest lot line-------------------------------- - - - ----------------------------------------- - yy yyy i r" 4 Remodeling and/or;repairing`(describe):----_- - -------�. ;-iT --- f1� � � �'�� " � J EFZ-�-b-------it1LlT1-k �1.T► / > T �� ---------- -------�Na- N-t------------�-R!t©.�b-----------------10-X_ I hereby certify that 11 have prepared this application and rtha}the work will be done in accordance with San Joaquin County ordinances, Sfa ws, and es and regulations of the San Joaquin Local Health District. (Signed)------ t•I��TL. ----------- ------- --------------------------------------------------------------------(Owner and/or Contractor) a C -�....w -- Y - _ _ I� . - -- r- By:-- ''. iC?-_-•-•----------- ------ ---------------------- ,�. (Title) - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse Sid_-_:e) Phi— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------------------------------------------- DATE----- Q" REVIEWEDBY--- ----------------------------------------- -----------------------------------.--------------------------------------------- DATE--------------------------------------------------- BUILDING PERM I.T,rISSUEE?_:,- _---,=�=-m-� __-_-=- • - — - — DATE_ .------- -- Alterations and/or recommend;tions:-------7---7-------7----7-------------7-------7----7----------- 7-7 --- -7 ----- - � 0 -- - ------ •7---- - ----------------•--- •------• -------- -- - : -- `'s 1yA141 '� . ----------------------------------------------------- - ---- -- ------------------ - ---- --- ---- - -- -- FINAL INSPECTION '.- ------- ------- --- -- ------------ Date--------- _-------�(i___-��...--------- ---------------------------- SAN --- - -- 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 r: £S 9 REVISED 5-59 3m 3--63 r.p.CD. t �