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r FOR OFFICE USE: J j (.. Permit No. _,l #_- --------------------------- --- APPLICATION FOR SANITATION FERMI 6 -=- Date Issued __--- ------------------------- --- ---•�-- ---------------------- ----------------------- (Complete in Duplicate) Date �t a -- -------- -- ----- This Permit Ex ires 1 Year From Date Issued �/J ------------ ----- ------------------- --- 'r= � Cj}40(VJ - hereby made to the San Joaquin Local HealthDistrict 549.a permit to construct and install the work herein escri e Application is h Y �j This application is mad compliance with County Ordinance f ��---_,-_P_�_S-•---___---- -- �F ip �' JOB ADDRESS AND LOCATION------------ ----------------------- ----------- ---- ----- ---- -------- ---------- -- - Phone---------•-------------------------- -v _ GA��_Q a nl =• --- - - Owner s NameALS----------------- Phone --------- e----------------- Address----------------- U-5 •--------- °n -------7 Contractor s Name-_- -- Cammerci4 ❑ Trailer Court ❑ Motel ❑ Other ❑ � � Apartment House ❑ � RES Installation will serve: :Residence a p Q-.---- 1 _-_. Number of bedrooms -Z Number of baths I1Lot size ---� Number of living units: __ eft. Private Pth to Water Table-- Hardpan Water Su 1 • Public system ❑ Community system ❑ Cla Loam [ Clay ❑ Adobe❑ pp y� Gravel ❑ Sandy Loam ❑ Y No ❑ New Construction: Yes No ❑ FHA/VA: Yes Character of soil to a depth of 3 fleet: Sand ❑ Previous Application Made: (If yes,date_-.--.--- 1 No TYPE'OF INSTALLATION AND S.F.ECIFICATIONS: u ION—` vai �_, . t (No septic tank or cesspool pd,if public seweavallablewtt iri 200 ft:e±. Ma �rlal - C�_ Distant from foundation--.J -- QQ7-- Distance from nearest well--- -- x� Li uid depth__. -- - � Capacity--- Septic Tank: Size__ _--- - q No. of-compartments- Q Distance to nearest lot line- ------ ---•-- I Distance from ayndation---- - t ------- - ----------- I Width of trench-------------- s N /r Disposal Field: Distance from nearest ell_:_ -- Length of each line______-- -- -.---____.. l Number.of line s__._____ Total length_-----.---- - th of filter materiaL__._�-��---- - � _Type of filter matenal_ ��=K----Dep ---___.Dista e to nearest lo# lin -� . Distal from found � . .__-pepth,. --.--- p -ti i Distance to nearest well__- Q eter. Seep Pit: Size: Diam .. Number of pits-------�'------ ----Lining mafenal_ Q.� ------ -s_. . gals. Distance from nearest well from foundation._-____. --_---.Lining material___..___-. Cesspool: ' ci Y - : 3 , Dep#h------ ---------------- -- L qu d Cap ❑ ' q�S ize iameter - , - iMstance from nearest building______ __ __________ F Dkstance onixnearest'w_ell_ Prav - -------- - . "�`.* " I QistaR e to nearest+cline ---- ----- �....- ` �P15F j1 Remodeling and/or re firing ldescribe): l- � f� �. �,e>`1 �,a f�( ��.�-r------------------ -- -I _ �r = -------------------------------- o --------- ---------------------------- -1 - r _ ------------ y, R . . :. ----- ------------------------- re ared this application and that the work will be done in accordance with San Joaquin County i I hereby certify that I have p p ordinances. State laws, and rules andNans of he San Joaquin Local Health District. .(Owner and/or Contractor} _ -�. - -•- - -- AA'-Si4g1rn.ed]-Y- stern tr+�eiation � -- „Mcan<be, .. - -- --- - - - side -- - - -. Placea'an'reve ..... buikdings, c „ . (Plat plan; showing sae o_f lot,ioca t FOR DEPARTMENT USE ONLY -------------------------------------- DATE_----- ---/------�---- APPLICATION ACCEPTED BY_.__ r- --�--------- --------- - ------ DAT E------------------------------------------------:--------- REVIEWED BY------------------------------ ---------- ----D . BUILDING PERMIT ISSUED-------------------------- ;._ ---------- DATE--- -------------------------- -------------------------- Alterations and/or recommendations_______________________ ___ -- __-__ --•------------------- ------ ----------- --------------- ------------- ---------------- ------ ------------- ` . ----- --------------------------- � m Date----._.- -��-�-��-1---�-- ---- --------------------- FINAL INSPEC SAN JOAQUIN LOCAL HEALTH DISTRICT k 124 Sycamore Street 205`West 91h Street 3oo West Oak Street Tracy,california 1601 E.kaxelton Ave, Manteca.California Lodi,California Stockton,camornia Ec1. 9 REVkS Eq 8-59 3M 3-'6� F.11