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FOR OFFICE USE. --------------;�n-- ---------- .. ........ ............. . ..... APPLICATION FOR SANITATION PERMIT Permit: No. --------------=---- ------------------- --- (Complete-in Duplicate) ---------------------------------------------------------- 7 This'Pei'mit Expires I Year From Date l;_su'e'd 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 AUUKtZ),J AND LOCATION-------- ---------- Ift / 7 E -------------04 ........... -- ---- ---------- Owner's Name----- -----AVI---6-ho.-MIn-------a ASIA=17-m4A _49-S----- ----------- - Phone Address.. ------------- -•------ &P- AAr_M_A7 I----------- 1----------------- =------------------------------------------- -------- _1---------------------------- ---- Contractor's Name------ - ------- O- IS --------------------------- ---------------- Phon14 _6iK Installation will,iserve: Residence's Apartment House E] Cor6lmercial E], Trailer Court E] Motel [] Other F] Number of living units'!, Number of bedrooms Nu;ber-of.b'atks.I----- Lot size --_---------------------- f . Wafer Supply: Public systemN�t Community system E] Private r-1, Depth to WatiTable ft Character of soil to a depth of 3 feet- Sand E] Gravel 0 'Sandy Loam L) Clay Loam E] Clay [] Adobe Hardpan ❑ Previous Application Made: {If yes,date-------_---------- } NoNew Construction: Yes E] No FHA/VA: Yes [I NOV ) 0 I . TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available withiV,200 feet.) Septic Tank: Dist7a'n7c, from nearest well A— P- tbist'rice from found8tion---1 ---- --- ----------Material ----------------- -- -------------- -------- EJ 5*4 STO INo. of compartments--_..-----------------Size---p--------------- -----------Liquid depth--------- ------- --------Capacity------ ---------------- ear%l vellA7 D,sfan�e from f( ------- Disposal Field: Distance from n :)unda on-- Distance to nearest Ii e__Z_40,�' Number of line �01 ...Cengtl� of each line Width of trent I __.__ - -LM 40 Z 1-fe Type of filter material__ _._.-Depth filfer*mafef I -:1-it-------..---Total length____CK5-------- 1 1 10 -_._Distance from foundation__ /0 Seepage Pit: Distance to nearest well 47---D d-nd tion__A_.,5*/-.__,Qisfaye to nearest lot line--------- ------ 0A) --- 4 Q Sd Num"ber of pJs..0_NeQ Lining materialkha.K...4-Size: Diameter ------------D,pfh__ 04-l" 6 1 ------------- ------- Cesspool: DiifE-n-ce'f7crii"nearest'well ell-' ------Disfan'ce from foundation----------------i _,.Lining material_______________________________--_ - ❑ aterial----------------------------------- -F1 Size: D;ameter- _ --------- ----- ------ -- - -.De- pthl------------------------------- ------ ---------Liquid Capacity-,---------------------gals. Privy: Distance from nearest well............... ...... ------ - _ -k......Distance from nearest building-_-___.______-________-_____.--___.___-. ❑ uilding----------------------------- --------- -- F1 Distance to nearest lot line .-.-..... ------- ------ -I - ---------------------------------------------- Remodeling and/or repairing (describe):-- ------------- ------------------------------------- - ----------------------------------------------------------------------I------ ----------------------------------- ----------------------------------------- ------------------------------------------------------- ---_ t -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------------------------- ------- ------------------------ -- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- -- --- ---Eii.,; I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, State la,,w,s-A?rd have----prepared regulations of the San Joaquin Local Health District. T ---- - --------- -- - --------- ..... ---towner and/or Contractorl �.L_Ak S {Signed}..- -------- --------6--_.-P-, .. . ., S 0 - ---------- .................. By:----------- -------41.!---------- ------ - -------1...(Title)------�� -- ---- -------- --------- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------------------------- --------------- DATE------- r REVIEWED ATE-------- REVIEWEDBY------ ------------------------------------ - ----- -------------------------------------------------------I------------------ DATE-------------------- BUILDING PERMIT ISSUED-----_-- --.---•----- e an or recommend ---------------- Alterations d/ ations. ......44t, zwa,��----- ---&,--- --- _/- -------------; -- ------------------------------------------------------------_--------- --------------- --------------------------- ------------- ---------- ------ ------- ......-11............ -----------------------------...........--------- --- ------------- ---------- - ---- ------------------------------------ ------------ ........ ----------- ------ -------- - - ------I-------------------- -- - ----- ---------------- ............. ------ ------- ------------------------------------------ FINAL INSPECTION BY:- - --- - ------- ----------- Date....... ?7_176'_- ---------------- ---- - --- --------- SAN JOA IN LOCAL HEALTH DISTRICT 1601 E.Hazotion Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Mont*Car California Tracy,California E.H.9 2M 1-67 Vanguard Press