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/ APPLICATION FOR SANITATION PERMIT Permit No- _------- �f 5... (Complete in Duplicate) 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. JOB ADDRESS AND ►LOCATION = 2487--- ry kee__Lane -t -St-ock' h, Owner's Name---------------- r_9---------------------------------- -t .-- ------ Phone.:-HO---59327-------- -------- ------------------- --- --- - Address----------------------------------------------------- - Contractor's Name--VU--- C---N_T_GB1"�SFtPT_1C__-_T_AhJK---SVCi-I----------- ---=----------------- - ....... ---a7 ------ Installation will serve: Residence MAparfmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __a___ Number of bedrooms 7_2___ Number of baths-.,__.= Lot size _______5�-t 1,2.5f - f� Water Supply: Public system EUCommunity system El , Private ❑ Depth to'Watree Table __.__5CF1:-"' Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe XX Hardpan ❑ i Previous Applicefion Made: Yes ❑ No = New Construction: Yes ❑ No EXX FHA/VA:.Yes ❑, No [ ►k* TYPE OF INSTALLATION AND SPECIFICATIONS: I ; (No septic tank or'cesspool�pemitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well_________________Distance fromfoundation_____________.-____.Material----_-___'____________ No. of compartments _____lCa Ex�tin p ----------#Size------••---- -- -------------Liquid..depth-�-----------�- -- acit Disposai Field: -Distance from nearest well____None'Distance from foundation___ Qr20-Distance to nearest lot line___ ExiAtin 1---------- ----------- 'Length of'each'line---------15-- - _.Width of trench.------2 ....................... 1f � Number of line, _ - t ." & Acid Type of filter material___Se- � $k_,Depth..of fiter ma#er ____.___18L _Total_en lial " lth_A___.____ r _____________ � gJ� Seepage.Pit: Distance to .nearest,-�tell Nrina ____Distance from foundation____3.5-__---___.Distance to nearest lot line___ZG ; d �. R 3311 X$ Number 6f pits Lining matenal__-__oc�__ _ ____Size: Diameter. '_____ ..........De _._�__2.��_ � _ Cesspool: Distance from jnearest:v4l "w Distance from foundation._-.____ .----_Lining material_---------- __._ __-___ ❑ Size: Diameterl' - ----;_#Depth--------------- ------------------------ --Liquid Capacity---"--4----------- gals. Privy:' Distance from i ea est well ------------------------------ -- ___Distance•from nearest building,_ - `_ - __________ i _____ Distance to nearest lot 13ne_�_ _ ❑ N _ - -- -- ' ' Remodelin and/or re airin describe :__._ 'I`�` �E 1_ lll ~ti llI`��11a 9 / p. g I g y- ge----------I------- -------- ----` ,. i -: , . I "�`. t y - ) -i fti .. I _ __ ________________ _________ ------------------- •_______-___._______-____ ________________----_-. _ _ _ 1. -_'--V_______________ E-_--______ I hereby certify that l have:p 6epas�d this application and that the work will be.done in ac ordance with San !Joaquin County ordinances, State laws; and rules and regulations of�fhe San Joaquin Local Health District. fS► ned IDAY &WIGHT SEPTIG TANK S IF . • - = d 'g )----•----------- --------------.:--------:----- -- - ---- ------ of By:-_------------- -----------=-------------- ---_ - --- .�`-'t- ± �-�- --- itl6l - -- .- _ - ntra or) {T 0 ---- - . ( p g;sae of lot, locaionf system in relation' o`wells, buildings, etc can be pl on reverse side). Plot plan. showin ! --- -�*--�-FOR-DEPAR+ MENT USE ONLY "�- `:. /'""., —"_► APPLICATION ACCEPTED BY ----- ----------------- ELATE--------- 1 REVIEWED BY---------- f : f Jk� (Vi7� ---'DATE------- ---------------------------------------------- 14BU1LDlNG PERMIT ISSUED ' ' ` --------------- --------------------------------- DATE --- ---- . a Alterations and/or recommendations:---`----=------•----------------=-- 1 i, 4 -------------•----•----------- ----f - --------------- - . ' -- -- -----•------------------------------••-----==- - - I �L T FINAL INSPECTION BY:. 3- --C- 4- ' :.=----:._ -- - Date__ Val_, -_-:..__ _�.� _ ----- --- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California-' Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.