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>.�hFICE USE: r y - /003 ------------------- __---_ - APPLICATION FOR SANITATION PERMIT Permit No. { ----------------- (Complete in Duplicate) ---4 ------------ This Permit Ex fres 1 Year From Date Issued Date Issued Z--�'5_'44� r 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. JOB ADDRESS AND LOCATION-----130-------- - . . f=.-...- �` T) lT Owner's Name-----------------Li .__._. r Phone Address-----_--------- -•---Box-------•-`3--�f'' --• � � � --------------------- 1 -Contractor's Name------Fu ----- `--------------------------------------- ----- Phone.-------•-•------------------------ Installation will serve: Residence Apartment House ❑ Commercial;❑ Trailer Court Q Motel 0 Other ❑ y Number of living units: __. ._;Number of bedrooms_3___ Number of'.baths . __._ Lot size _._1a'Cga v Water Supply: Public system Communit s mTable,/19- , �y y y ❑ Private ❑ Depth to Water Table:I4�'_- ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes;date--------------------) No New Construction: Yes o ❑ FHA/VA: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - --:-'—(No septic fan k•or`cesspool=permnittedTif-pub{ic-sewer--is°available=within,200-feet:]= -��- � - �.�F.4 Septic Tank: Distance from nearest well_c-i-W-_-Distance from foundaton__._/49---------Mate ial__--CAHI'( -RE.T.F._.--.----_- P - Size_Y Y-�Q- _'Liquid ' No. of com artments...._._.._ _ -_-_.___- depfh__'' - Capacity k2. Disposal field: Distance ;from nearest ell.C.-7d1,t__._Distance from foundation.--,� -------_-Distance to nearest lot line_-_ .._..___._ Number of lines_________ ____________ ___-_ -_--Length of each line '�� -'-Widthy$.�_ 3of trench Type of filter material._.- O. 1 -.---Depth of filter material------_ ----Tote! f l length-----------�� ---_-----____- to SeeP '9e Pit lar rest well _ _ Dae from foundation Distance tona �st lotline---------------- if pts Lining material zenDiameter._._ Dept ---------- - Cesspool: Distance .from nearest well-___-_.---------Distance from foundation_------------------Lining material-------_-__-___----------- Q ❑ t " size: Diameter - Depth --------- ------Liquid Capacity-.- gals. Privy: Distance from nearest well-------------------------------_---------------_Distance from nearest building ❑ Distance to nearest lot line-------------------------------------------------------- Remodeling and/or repairin (describe):----- ---. -------- ------------------------------------- ------------------------------------------ ------------- ` - ---------=--------------- -------------------------------------------------------------------•------------------------ -------------- " I hereby certif at h„ve preps ed this application and that the work will be done in accordance with San Joaquin County it ordinances, St t . aws ales and e6ations of the San Joaquin Local Health District. (Signe � B :=_: = = �=-T=" = 1 � - --- --(Owner and/or Contractor] _k �_ -., w .. . (Plot plan, showing size of lot;'location of system in relation to wells, buildings, efc., can be placed on reverse s..i.de). .r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- R-'- ------------------------------ -- --- -------- ---------------- - DATE- ----- ---�- ---`---��'-'--------------------- --------------------- -- --- - -- .xi ------- ED BY = - --------------------- DATE BUILDING PERMIT ISSUED------------------------ --------------------- ----------------- DATE t Alterations and/or recommendat ions---------------------_---_-._ ., - t rt ----------------------------------- _ ------------------------------ ---------- ______._..__--__-. ..____•_____•--- -------------- .-- --. i. --- -- -- --------------- 'I ____________________________________________________________________ FINAL INSPECTI _ Date �.'-f��f— hL�-- SAN JOAQUIN LOCAL HEALTH DISTRICT Al 1601 E.Hozelton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cd. f - � 6