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APPLICATION FOR SANITATION PERMIT Permit No. (Complete ate in Duplicate) Date Issued A 'a permit to construct and install tThn work herein described. T�plicafion is hereby made to the San Joaquin Local Health District for 1\1 o. 549. is application is made in compliance with County Ordina JOB ADDRESS AND LOCATION;-----bocl------f:-1---•- 56 ------------------------- --- ----------- one------11----------------------------- Owner's Name-----------------ic;�-O-e------+4......sous__&------------------------------ ------------------- ------------------------ Address------------ -- --------��------- -- - -------- ---- ------- ---------------------------------------------- Contractor's Nam ------- ----------- 1C1_QW _v_y_�C6--------------------- ph Installation will serve: Residence 0-_Apa rtmenf House Cornmercial E] Trailer Court E] Motel 0 Other 0 umber Sf'bafths __,i_ -Lot size ............. Number of living units: Number of bedrooms Water Supply:-PuHic-system E] Communiity system El Private V?-6epth f.c, Water Table --- --- ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam E]r. Clay.LoamEl Claycl Adobe Hardpan E] Previous Application Made: Yes E] No2�N�e Construction: Yes 25�0_Ej FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: f .)* (No septic tank or'cesspool permitted if public sewer is avai1a6le within 2010 eet , -------Mater ---------- ----- 'at n - - -------- P ___6_�h -S cl-pt p city--- ----Q Septic >er Distance from nearest well-5--b------Distance f n( --- ------- V Sep �af ion _0 Q _!__Li qui N6. of compartmen.fs_,=,�-- ---------Size.- Liquid.dep.t ------- ------Cap I n--- --- D i,ta n7lIf from 0 nearest lot line___-v5 ....... D'Mance from nearest well- .`Distance 'u dation--- -------------Distance-to Dispos;�We d: I Z wr-s-rs of each --- -------- --------------W',afh of trench----- Number of Ii ne-T-T/ Leng1k ___dr-------------- +0--Depth.of filter material-__:__1.2------------Total" ;length--------1Z-- -- -----------•------- Ty* e-of filter material R), p C-1-------- Seepage Pit: D-istance to nearest well-----------------------Distance from foundation---------------------Distance to nearest lot line---_______--____ ❑ ine----------------- F-1 Number of pits.------ ------Lining material-----------------------Size: Diameter---------------------- Depth----------------------- --------- Cesspook, Distance from nearest weil-----------------Distance from foundation--------------------Lining material___---__-____- ------------------ ElSize: Diameter------------------.--- ---I---------- Depth---------------------------------------------------Liquid Capaci+y----------- ----------------gals. -------------------------- ------------ 'Privy: Distance from nearesf'well---------- --------------------------------------Distance from nearest building ElDistance to nearest lot Dine-=------------------------- --------------:__1----------------------- --------------------------------------------------- ---------------- Remocleling' and/or repairing i (clescribe) - r DAY- -&-NGHT W-------------------- --------------•------------------------ --------------------------------------- ------------ - ------ ----------------------------------------------------- ------ SepffieTank-Servi 7 ---------------------------------------HO-24046------------------------I----------------------- --------------- -- -------- -------------------------_-------------------------------------- Act _r ----------------------------------------------------- ------------------------------------- -------------stis, O.Rf _01W I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a S. and rules an �eigu a ions Jos u;n Local Health District. ordinances, d I fibn of the San Contractor) ----------------- ----------------------- (Signed)__!------- - ------- -or -------(rifle)---------------------------------------------------------- By:-------------------------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in.relaf* 0 Wells, 6uildin etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 9f--------------------------- APPLICATION ACCEPTED BY----;------- -------------------------------------------------------------- DATE-------9--1 q ------ DATE-------------------- ---------- ----------------------- REVIEWED,By------------------------------------- -------------- ------------------------------------------------ BUILDING PERMIT ISSUED--------- S. --------OIX---L------------------------ DATE------------- -.----=-------------"-------------------------- ---------------------------------------- Alterations and/or recommendations:------199Z7T.1--- ---------------------_---------------------------------------------------------------- ----------�3------- � ----------m-5-----------4 -&----------- --------- --------------------- ----------------------------------------------------- ------------------------------------------------ --------------I--------------------------------------------------------------------------------------- --------------------------------------------------------------- I - i -------------- I --------T_ ---------- ------- ---------5 F,_jA c--------T A-N-KIS--------1--_------/_jE57A_C_H------- -------- - \ ---------------------------------------------------- ------------- ---------------------------- ------------------ ------ -------------------------------------------- --------------- ......... FINAL -INSPECTION;-BY. Date 4,. fes �71 --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street no West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tra.cy, California ES-9-2M Revisso 1-57 FP,C0.