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FOR OFF!CE USE: -----------------------------;------------------------------- 'APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ---------- --- --- - ---- ---- -- (Complete in Duplicate) Date Issued - -------------------------------------------------- This Permit Expires.1-Year From Date Issued -e Application is hereby made to the San Joaquin Local Health District fora pmif to- construct and install the work herein described. This application is made in compliance with County.Ordinance No. 549. JOB ADDRESS AND LOCATION' ----DI j------------ --------- W--------- -----------------MqgrF-----14--- --- ------- ............ . Phone------------------------------------ Owner's Name-----------:1- Ami-EV-6-----------5M_170----------------------------------- --------- ---------- Address------------- ----b4f-------- C-tj-------------------- ---------------------------------------------------------------------------------- Contractor's Name_ -----------------:-------------------------- ---------------------I---- Phone---------------------------------- Installation will serve: )Residence PErApartment House,3 I- ,,Comry�ercial E] Court ❑ M4tel E] Other E] -V. 1 4 F If e—r' f-livin' Lot size ................ Numb o 9 units.. 4,- Number of beclrolollms Number of s - ------------- Depth to Wafer Table 51 ft. Water Supply. Publicjsy-5tem� El Community system El Private Character of soil to a depth of 3 feet: Sand 2]-'-Gravel [-] Sandy Loam E] !Clay Loam 0 Clay [] Adobe 0 Hardpan 0 Previous Applicafion Made:'#jIf yes,date-------------------- No��New Consfrucfion:(Yesj&4-'1qo E] FHA/VA: YesX;--f4o El TYPE OF INSTALLATION AND SPECIFICATIONS- :0 ------i--(Noseptic-fank'or ce2pool permitted--if public sewer isavailablewithin-200-feef.)- - from foundation____!Septic T k: Distance from nearest well--------- Disfarice ion____/49------ Material--- Liquid depth----- !T--- ..........Capacity_M__ _jo------ No. of compartments_______ -- ------ Si4 I i k Disposal Field: Distance from nearest well_____6_4D---Distance from foundation--___ Distance to nearest lot line--_ _...-...- Number ;f lines._._____ -----------------Length of each �__ .Wldfh of tren6--------- --------A.. 0 Type of filter materidI'_'jR46_GK----Depth of filter �aferiia[.Ilj__�_._"---[-.Total length-------- --------J-5-49-------- ? --.W 11 1 Seepage Pit: Distance 4o nearest well - -------------0---D'isfance frdM-_ foundation---- ----------.-----Distance to nearest lot line_________________ id F-I Number of pits----------------------Linimaterial---- ---- t'.- .......Size`:JDiameter_-------------------Depth--------------------------------- Cesspool: DiOancefrom d n ounkafion--- ------------ ..Lining material_____._____________________________.nearest welf',.--------------Distance f r'!;�f 171 Size: Dla�neter----------------- -----------.-Depth----Y ----...................I, Liquid Capacity--..------------------------gals. Diad 4�v > Privy- Distance from nearest 'a W _----------- ---------------------------- ---Distance from nearest buil&ng----------------------------------- 171 Distance to nearest 41ine--------------- - ----------- -- ----------- - ------------ ----------------------------------------------------------------- Remodeling and/or repairing (describe}:------------------------------------- - - --I------------------------------ ------ ----------------------------------------------------------------- L__ _ _-_ _1 I 1 .1 - ------------------------------------------------- -----=-_------------------------------ -------------------------------------------------- 1-4 wtv.11 ------------------------------------------ ---------------------------- ---------------------------------------------------------------------------------------------------------------- I P- P^W .40 V I J ------------------------------------------------- --------------------------------------------------------------------S------------------------------------------------------------------------- ------------------------- 0 ' t-v, IL — *.,,- i & I hereby certify that I have prepared this application and'th'af.1the �vo_rVwilObo done in accordance with San Joaquin County ordinances, State laws, and r`ules and regulations of the San Joacl6in Local Health Districf. (Signed -------A------ ------ ------------------------- ------------I------------'-------------------(Owner and/or Contractor) By—:-.---- ------------- -- ------ ----------- ----------------------------------------(T1tI4____—------ _:----------------- - --- -- --------- ---------------- ----------------- -- (Plot plan, showing size of lot, location 10f,systern in rela�ion to wells, buildings, etc., can be placed on reverse side). FOR bEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------77�&_O-------------I------------------------------------- ------------------- DATE---- 7-------------- REVIEWEDBY---- -----------------------I--------------------1,---------------------- --------------------------------------------------------- DATE------ --- ------------------- ---------------------------- BUILDING PERMIT ISSUED_-I------------------A---------- ----------- ------------------------------------------------------- DATE----------------------- ------------------------------------ Alferaiisons A_nd/c�r _4E�-�_ - -- ----------- --------------------------------:----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- --- -------------------------------------------------------------- ---- ------------ -------------_---------------------------------------------------------------- ------------ ----------------1_,L_R__ ------------------------------------------------------ - ------- I-- --------------- ------ ---- --- - ----------- ------------------------------------------------------------------------------------------------ - -- - ----------- ------------- -- - -- ------ - -------- -- --- - ----- -- ------- -- -------------------------------------- ---------- ---------- ---------- - --- -- ---- ---------- ----- --- -------- FINAL INSPECTION ------ Date-------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.