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FOR OFFICE USE: ff MpuHtufr z .,. �j/q.— O2 11 APPLICATION FOR SANITATION PERMIT Permit No. �2:_,C7d- -----------------_............. ---------- --------------------=----- --- ------------------M (Complete-in Duplicate) .�...=�.�` ...------------------------_-----___-_.._--- _ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made toE;the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in co' I' a with County Ordinance No. 549. f ! 0 � �� MT 'lli � JOB ADDRESS AND LOCA T11 NI -----GORM 4--- D_R�----------------------- ------ 0.........U/V_(-Ca--•------Rb�------------- Owner's Name------- --�-----'~�-.x__._.L!.!.F�.��_�_� ------------------------------------ ------------------------- Phone----- --------------------------- Address.------------_ - �.?.�.......---BQx--------f.�.�.�-----------------rl.A_IVTCC.1q. Contractor's Name_CA.L!.FJII!... RgCFn57E NFr -----------------------I ------------ ----- ---- -- -- - -------------------------------------- Phone------ •----------------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ } Number of living units:',,'_ _ Number of bedrooms -3--_ Number of baths Z. Lot size _.!- -�_© _.t3__ ________________ Water Supply: Public system,�❑ Community sys m ❑ Private Depth to Water Table 1. _ ft Character of soil to a depth ofiiPiiP 3 feet. Sand [Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: 111 yes,date_.-------_-----..._ No R---New Construction: Yes �o ❑ FNA/VA: Yes F`_'No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: -- (No septic tank-or-ce4'ooi-permitte&if-public-sewer-isavailable-within=200-feet.)--iiii. — rom foundation--. ._. -----------------Tank: Distance from nearest well-------- _..._Distan e fQCONC No..of compartments._._.___._._ Liquid de th___41,1 Z�© Disposal Field: Distance from nearest weft......SQ_Distance from foundation----------40_-.Distance to nearest lot Fti� Numberrof lines_____-__-_`7�______----------Length of each line_7S-} 75-----Width of trench.......Z�4..................... Type of f4er material_=__Fi-QC•K._.Depth of filter material-------V7..........Total length_________________�-`^__ ____._.______ *� Seepage Pit: Distance tlo nearest well_________________ -_-_Distance from foundation___-----------------Distance to nearest lot line----------------- ❑ Number of pits--- ---------------...Lining material---------------------- Size: Diameter-----------------------Depth............--------------------- II, Cesspool: Distance f''om nearest well ................Distance from foundation_____._____.._-. ..Lining material------------------------ ❑ Size: Diameter- ------ - ----- ----------------Depth------------------------------------------- Liquid Capacity----------------------------gals. :I Privy: Distance from nearest well-------------------------__------___---_------- _Distance from nearest building------------------------------------------ -- 171❑ Distance to nearest lot line---- ------------------------ -----------------------------------I--------------------------------------------------------_-- - i Remodeling and/or repairing((describe):----------- ----------------------------------------- ----------------------------------- ----------------------- --•----------------.. -------------- -------------I---------•-------------•---------------------------------------------------------- ---------•----------------------------------------•---- --------------- -------------- I hereby certify that I have prepared this application and that the work will be,done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �r (Signed)- --- ! ------------------------ ------ (Owner and/or Contractor) B = ah - (Title,` ----- (Plot plan, showing size of Iot;If location s tem in relation to wells, buildings, etc., can be placed on reverse side). �f FOR DEPARTMENT USE ONLY 1 II APPLICATION ACCEPTED BY-------- !. -_ .---------------------------- -- - - ------------------------------ -- DATE---- --`--��-Y-.�'- ------- ---------------- REVIEWED BY------------------------- I-------------------------------------------------------- --------------------- -------------------------------------- DATE_--•---------------------------------- d --------------------- BUILDINGPERMIT ISSUED.---!(-- -- ---------- --- ----- ----------------------------•--------------------------------------- DATE------------------------------ ------------- --- ----------- Alterationsand/or recommendations:----------------- -------- - ----------------- ---- ------------ ----------------- ------- --•---------------- ------------------------------------------ ) ---------------------•-------- ----- ------- ------ -------------------------------------- -- --------------------- ----------------------------- ---------------------- ----- •---------- --- ------------------- M ----------------------------------- -------------- ---- - -- ----- ------ ------- -- ----- ---------------- ----------------- ------------•----------------- ...... ......111.-- . ------------- . . - II. ---.-..-..-------------------- -------- ----------- --------- - - - ------- --------- - ----- FINAL (NSP BY - - Dafie...-.------ G =----=i------------------•-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haaellon Are. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street ' Stockton,California Lodi, ColiFornia Manteca,California Tracy,California E.H.92M 1.67 Vvnguwd Press