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APPLICATiON FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ----/-O�-7/f7- <br /> Application is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance A. 549. <br /> JOB ADDRESS AND TION,---- ----------0- ---------6- ---�•-�---�---------------- ------------------------- ---- <br /> Owner's Name------pp-------- A-1 __I...... ---JD. `t t------G----------------------- -------------------- ---- ---- ----- -- Pkon.0 7-J------ <br /> Address----- RS- ----1S4t­--% M <br /> ------------ -----------------------------------------------•-----•-•-------- ---- <br /> -------------------------------------------------­-----------------------------*---------- <br /> ------------- <br /> P <br /> 7- --------------------------- ---------------- PiconelljOSX�44, <br /> Contractor's Name--- F-k------d)-�y---- ---`yrs <br /> Installation will serve: Residence X Apartment•House E] Commercial E] Trailer Court E] Motel Ej Other E] <br /> Number of living units: -)------ Number of bedrooms -,2,- Number of baths -1---- Lot size ______________________ <br /> Water Supply: Public,system Community system E] Private E] Depth to Water Tablec6q ft. <br /> Character of soil to a. depth of 3 feet: Sand E] Gravel El Sandy Loam Ej Clay Loam F1 Clay 0 Adobe 0--"Hardpan E] <br /> Previous Application Made: Yes E] No � New Construction: Yes,!�, No E] FHA/VA: Yes E] No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permiffed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-44.01u-�-Distance from foundaflon--M--1------Material------ -------- <br /> No. of compartmerifs-­e�...................S iz e--_ZZI-"/ -'!...Liquid kciepth-Z-oo"----------Capacity-geo- jx <br /> $- K 0 3r' <br /> Disposal Field: Distance from nearest wel IAA-aa&-­Distance from founclafion-2-0.........Distance to nearest lot <br /> Number of lines-----I----------- ---------------Length of each line--"9-&`-­--------- Width of french------- -------------- <br /> Type of filter material- r-kk-Depth of filter material---- length----- -------------------------- <br /> Seepage Pit: Distance to nearest welf­RvfiP---------Distance from foundation___1141------Distance fo nearest lot line--/P-1----- <br /> Number of pits­J----------------Lining material_R—d<---------Size: Diarnefer---.3.5-.or Dept h---.;.2,-,o------------------- <br /> `)�--,--esspool: Distance from nearest well-----------------Distance from foundation... --------------- material_____.---_--_----------_-___________ <br /> ❑ <br /> aterial------------------------------------- <br /> F-1 Size: Diameter-------------------------,----------- Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building--____..____________._ --,----._. <br /> ❑ Distance <br /> uilding-------------------------- --- ---------- <br /> Distanceto nearest lot lire--------- -------- ---------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and or repairing (describe):----------------------------------------------------------------------------------------- -------------------------------------------------------------- <br /> -----------------------------------------------------­-------I------------------------------------ <br /> -------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------'-­ - <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------I---hereby----certify--f-h-at I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws and rules and regulations of the San Joaquin Local Health District. <br /> L <br /> (Signed)---- 4cl-LiAk------ jt/c�------------------------------------------- Contractor <br /> BY!---------------------­­----------------------------------------------------------------- (Title)---------- ----------------------------------------------------- <br /> 7zc----------- <br /> (Plot plan, showing size of lot, location of system in relation to /ells, buildings, +c, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ----------------------------- DATE------ —--•--------------- <br /> ------------------------ <br /> REVIEWEDBY------------------------------------- ---------------------------------------------------------------------------------------- DATE <br /> -BUILDING PERMIT ISSUED--------------------- -- ---------I------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------- <br /> -P-�-------------------------------------------------------a---------- --------------------------------------------------------------------------------------------- <br /> ------------------------------------- jow----------tTFV ------------T-;-K ---- -- --------------------------­--------------- <br /> ----------------------------------------------------------- ----------------------------------------------------------- ------------------------------------------------- <br /> ---------------------- -------- ------------77 <br /> ----------------------------------------------- - - -- -- ------------- ------- --- --- ---------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------- ------ - - ------------ - ---- ------ ---------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPE6 !. E- -- - -- ----k----------0-- Date----- --- ---------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> -9-2M Reviseci 1.57 FT CO. <br />