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FOR OFFICE U.:- APPLICATION FOR SANITATION PERMIT Permit No. '.64-F -------------- ---------------- ---------------------- Ai (Complete in Duplicate) Date Issued -------------- ----- --------------------------__--1 . This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal h District for rmitt to construct a i9stall the work herein described. This application is made in compliahce with County 7rtq U6 0- ' 349 VOW .1 '010 JOB ADDRESS AND r7. ........... "Ov�rwe� d!�, ----------*------ -- ----------- ---------- -------- -----------------------------------4K - Owner's Name------- ------- .�#I.ff------------ ------- --------------------------------------------- Phone------------------------------------ - �� 1# IC Address -------/ycz ......a.7-1----4,,. -------;----------------- ------------------------------------ Contractor's Name..... -------------------------- ----- ------- - -------------------------------------------- PhoneP --- ----------------- Installation will serve: Residence [�rApartment House E] Commercial E] Trailer Court L] Motel [] Other ❑ Number of living units: Number of bedroomsqg... Number of baths._/--- Lot size -j--Of Cfe s ------__:-- -------------- Water ----:----------------Water Supply: Public system E3❑ Community system E] Private 2q""Depth to Wafer Table/ - ft Character of soil to a depth. of 3 feet- Sand [+Grave; [] Sandy Loam F] Clay Loam Ej Clay E] Adobe [] Hardpan C] Previous Application Made: (If yes il date--- No 9?""New Construction. Yes 0 E] FHA/VA; Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: _.(19c�septic�-,fankor,,cesspppl-p:er.mi.f.ted-� -r ee Q AF Septic Tank: Distance from nearest well-4?40-------Distance from joundafion_.-/40......... IC No. of compa4men1s_....Z-----------------Size-!?!.X. ----------- -----------Liquid depjh__4!�Pi��.. ........Capacitylla Disposal Field: Distance from nearest wel)_6_5". ----Distance from foundatiorka-r-_ Oiitalnce to nearest Iodine-YX----- Number of 66't........A----------------------Length of each line-1,O--r------------.Width of frenchcn?_Y_ ------------- ----M5 or10 t- Ty,pe of filter n�ateriaLQWor4_011C&_Depfh of filter maferial___/_47_'*-----------Tofal length--- ---------------------------- Seepage Pit: Disfanre to nearesf well........ ---Distance from foundation-------------------.Distance--------------------Dist�nce to nearest lot line----------------- ❑ Number of pitsl--- - ------- -------Lining material--------- ----- Size- Diameter-------- Depth.......... ---------------r------- ---------- Cesspool: Distance from nearest well -----------------Distance from foundation- Lining material-_-.....___....____.__--.--..-------- El Size: Diameterl-- --------- ----- ---- Depth--------------------------------:--------------------Liquid Capacity----------------------------gals, -Privy-:-- Distance from I nearest well------------------- -------..___..______________Distance from nearest I buiicling------------------------------------- ❑ Distance to nearest-lot line . ----b--------------------------- - � Remodel ------------------------------- Remodel ng and/or repairing (describe):__._-- W- ----- --------------------------------- -------- ----------------- ---------------------------- -----------------------------------------------------------11 -------------------- ------I------------------------------------------------------ --------------------- ------------------------- --------------- ---- ---------------------------------------------------- -------il---------------------------------------------------------------------------------------------------- ------------------------------ ---------------------------- --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ I hereby certify that'l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules aiid regulations of the San Joaquin Local Health District. (Signed}-------- -- ------ --------------------------- ............. ------IGWm4ef-ancl/or Contractor) (Plot plan, showing size of lot, location.0-L -------------- -- n of s-yjWe_m in relation to*-wells, buildings, etc., can be placed an reverse side). .4 6 FOR OtPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------................... ------------------------ ---- DATE. REVIEWEDBY-------------------------------- --------- --------1------------------------------------------------------------------- DATE ------------------------------------------------------------ BUILDING PERMIT ISSUED------- A-----------------------------------------------------------------------A--- ------ DATE'S Alterations and/or recommendations:----------------.---------------- - ------ - --- ----------- ------- 111" .11 ------------------------------------------I----------- --------- -- --------------------------------------------- ----- ---------- ---------- --------------- --------- ----------------- ---------- ------- ---------------------------------------- ---------------------------- ....... -------'-------------------------------------------- `--}-------- ------------- ------------------------ --------------------------------------- ---------------- - --------- --- ----:........ ------- ---------- -- ------------------------------- .........._------- --------- ---- .... -- ----- -------------------------- ---------------- 1110'. . ........ FINAL INSPEC 9..... Date........--,0---V SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Waxelton Ave. 300 West Oak Street 124 Sycamore Street 20,5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H. 9 2M 1,67 Vanguard Neu