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FOR OFFICE USE: Jl�-2-2 p �cj �rTt -------- Permit No. E ---/o `- _ APPLICATION FOR SANITATION PERMIT { - ----------------------- -- - ----- (Complete in Duplicate) 4AAW.. . Date Issued -_-•;-•----�-_- This Permit Expires.1 Year From Date Issued p� '2f Oto Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and,nstail the woft herein described. This application is,made in compliance with County Ordinance No.-549. mIU sOWrir ox JOB ADDRESS AND LOCATION.999X..,,10-7-----AIIY,,994V =:--------•1P....., fid .. CsN_ f ALL Esf.- gip -----_------- Owner's Name.----,WJ`?.,.----- ......",Fnic�Le.J�----------- ------ ------ Phone------------------------------------ Address------- -------•-•---------------•--------- Address-------- ---.... � ---•-------------------•--�--------------• --------------s+••-�----�--��---------------------•-------------...----. QX_ Ln��- Contractor's Name--- ---' - P21 �QIL ,�.... --------- -----•-....---- •-- Installation"Will serve: Residence 00'r Apartment' House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ❑ Number of living units: .._1--- Number of bedrooms .!V-- Number of bathst�_ Lot size ---67AP.----_ /......................rte .. � Water Supply: Public system C] Community system ❑ private epth To Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Saridy:Loam ❑ Clay Loam B-'Clay ❑ Adobe ❑ Hardpan U Previous Application Made: (if yes,date-------------------- No F-/New Construction:, Yes ❑ No [r*'_FHA/VA: Yes ElNo 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dist,%ce�from nearest well-----------------Distance from foundation--------------------Mater 691fS19N� ial.------------.._-----_-_......-.--.-........-_-.. ❑ No. of compartments--------••----------------Size-------•----------------•-------Liquid depth---------- Capacity_------•---------_--- t Disposal Field: Distance fr m nearest well,,'AW�_'.._Distance from foundation-JEW- t..._.Distance to nearest lot Length of each line--... --- ----• ench..--...A-Y..----...-----•.- [� �1iIS%1N� Number of lines------ ------------------------ � ....-----Width of tr� Type of filter materia!- Q -K---_-__-Depth of filter material-I --------------Total length -------- --------------- I�DJ. � Seepage Pit: Distance to nearest well--AW------_--_-Distance from foundation_-.. _'_-..Distanye to nearest lot line.... - - --._ � 'Number of pits......... ------- -Lining material_-_ C.NI(--.-.Size: Diameter-----4.. �' �.--...-..Depth------ '► �:. Cesspool: Distance from*nearest well--------------!Distance from foundation--"' -"--------_'.Lining material------------------------------------- El Diameter------------------------•----------i-Depth------ ------------------------------------------!Liquid Capacity-----------------•--_---...gals. N. 2 Privy: Distance from nearest well----------------------I---_----_----------------Distance from nearest building------------._----_.-.-..._--------- ❑ Distance to nearest lot line------- } -------------------------------------- --------------------------------------.-•-------•-----------•--------•-- t Remodeling and/or repairing (describe]:........ofo-------pv. --------:7Zrr--?,eFA4-----------------------------------.-------------------------•---------- ---------------------- --------- ---------------------•------------- ; -----------------•--------------------- -------- ---------- -•----------------------- --------------------•--•------------------ ----•------••------•••---...-----_..---------...-.-..-•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. " (Signed)------�-a P - 1,1 -_-----------------------------------------------------(Own er and/or Contractor) ------�� ..--- BY---------- v .. ?` ts-�---------------- --------------------------------------- (Ti#le) C Q/it' (Plot plan, showing siie of lot, locafA of system in relation to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY r DATE - - �� - APPLICATION ACCEPTED BY--- -- -- -------:---- --- ------ "/ REVIEWED BY------- --------- --- 5 --------------------------.. DATE - ------------------ ----•--•------------ BUILDING PERMIT ISSUED------------------------------ •--------------•-------•----- ------ ------- D TE..----•- ----;----- K--1---------------- -------------------- Alterations and/or recommendations:----------.-- . -_7 _ _" --------- -----------•• -----------------•----------------------- -------------------•------------- ; # .. .... ----------- ---------------•-•----------••--- --••---------------- - ------------ a 01 ------- t!� - /, ------�---------------------------------- FINAL INSPECTION BY-/V i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street j Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8.59 2M 5-62 ATLAS