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51 - FOR OFFICE USE: _ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -___----- --_- --- --------------------------------- (Complete in Duplicate) Date Issued __--` ------------------------------------------------------ This Permit Expires 1_Year From Date Issued Application is hereby made to the San aquin Local Health District for a permit to construct and install the work herein described. j This application is ade in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION, .. 1.1. P -� -------900---- • - j------QE----�-x-'-E�' -------R->-•-------------- Owner's Name npaaON�� _ j>_. r� --------- ------ -------------------------------------- Phone------------------------- j� Address-------_---------------- T •-•=� -� ..=f•• ---00---- -)P_0-A3---------------------- ------- -------- =r--------------- Contractor's Name------- _ ' ------------------------------- Phone----•-----------------•---------- Installation will serve: Residence 4;P-Apartment House ❑ Commercial ❑ Trailer Court ❑.,rMotel ❑ Other ❑ Number of living units: -1----- Number of bedrooms'A._----Number of baths _ Lot size ___ ________________ Water Supply: Public system ❑ Community system ❑ Private j?"bepth to Water' Table ft. --^ Character of soil to a depth of 3 feet: San4o"Gra, vel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dater.__:; - �'"" _)�o /`New Construction: Yes �� o ❑ FHA/VA: Yes ❑ No E ` .� 0 TYPE OF INSTALLATION AND,SPECIFICATION S.� [No septic tank o'' r cesspool permltted�ifrpublic sewerRls available. .i}hin 200 teat.), Septic / N�. of com artme�s--------------------------Size-------------------------------- -I -�----.Material-- � --- ------------------------------- N1 ----`-------- - - �_Size 1 Q -- , Liquid d de # �(tl[ � Distance from nearest well_________ Distance from foundation ____-_-___ h__________________________Capacity________._____-________ �r Disposal R Id: Distance from nearest weli_. _-.__Distance ffom foundation- ------ ____-Distance to nearest lot line___- ~�_. �+ Nu ------------ Len`th of ea Kline_ --- t ember of lines - "� g �] _�} �__-_.Width of trench "�- /41M Type - p -� � Total length---75 -- T e of filter matenaLo c Depth of filter material-2 ------------- Seepage Pit: Distance topneares&eli.._ ,__g__ Distance from foundafilon_---V0------- Distance to nearest lot line_- -______ timber of its--_-_-/ ---- __ -- -Linin material_ �_ _ _.5ize: Diameter_- - ).,:Depth-----7----------------------� Cesspool: Dirstance from nearest weli----------_______Distance from foundation ------------------- materiah,_-.---_ -----.-----_-----_____-__ ❑ Si3'e: Diameter-------------------------- ----------!Depth------------------------- - A---- -------------Liquid Cepecifi alJ ,y---------------------------9 Privy: DiHt�e from nearest well---------_______ ________________ -------------_Distance from nearest building __ _--- ----- ❑ Di fiance to nearest lot line -------------------------------------- ----------- ------------ -------------------------------------------------------- li Remodeling and/or. repairing (describe):------------------ --- ----------------------------------------- ------------•------- xt --------------------------------------- - ---- - ----------------------- -------•----------------------------•------------------- -----------------------------------------4------------------- ~-�* I 3 -------------------------------- ---------------------------------------------- --------- -----------------------------------------J-------------------------- I hereby cert'r' that I have prepared this application and'that'fWe work will'Le done in accordance with San'Joaquin County ordinances, St I sla es and reg ions of the San Joaquin Local Health District. +rErr+�rw (Signed)---- A --..e� - (Owner and/or Contractor 9 ) ----- / ) ! Y ---------- ------=----- TAR-' ? --------------=-------------- (Plot -------=- B :. [Piot,planE,shwingtiza off lot, location of system in relation to wells, buildings, etc., can be placed n7ever`e cle). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........77s_R.-._ _______ DATE------ 77A6.- _-____. f REVIEWEDBY----------------------------------- -------------------------------- ------------------------------------------------- DATE--------------------------- - - BUILDING�PERM.IT.ISSUED_.,.—__. .•� --=--= _=-= _ DA•TE.- - _ _ --- ____-- -------- Alterations'and/or recbmmendations------=--- ------- -------------------------- --------------•-------------------• ----------- -------- ----- -- ------ ----.----=---PLI-&---------------------- r° r. �i1'1tw�"i ----------------------------------------------------------------------------------------------------------------------------------- FINAL INSRECTIOl AL 2Iv Date---- s ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E F.P.C G.