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FOR OFFICE USE: -______________----. APPLICATION FOR SANITATION PERMIT Permit No. . 1_5�3 ------ � --------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 6 Application is hereby made to the San Joaquin Local Health District for a permit to construct andt:X ork herein described. This application is made in compliance with County Ordinance No. 549. -�t JOB ADDRESS AND LOCAT ON--- 1_C' �..._l_N/_it-----Q_ri- ----_----..... --- -, :t, 0LN --------w .-_�.S/ Owner's Name-----hx_._-__ _�..rr__�.___ N..�1�.� '-�-'--- -------------------------- --------------------- ------ Phone_14.17J-2.°Z---(--�---- Address-------_--------61-L-5------------S---------- N-------------------------------------5. 4.4--------------------------------------------------------- Contractor's Name------C-e_Y'+x_k...12...-A------ -----------P—Y-A------------------------- Installation will serve: Residence 0 Apartment,House=❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___l___ Number of bedrooms -3--- Number of baths _ Lot size -------2—.4. _.. --------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table Z�Q ft. Character of soil to a depth of 3 feed Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date--- No 9 New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-__5.0--.___Distance from foundation____I_a--------- '____ _.Material____ itaN_ 1r Te______________ �C '� V No. of compartments:_____... -___----__Size___...X_ __X___I.O.___Liquid depth_____-_-�.-___-___-Capacity__ -2-0 0-..--- Disposal Field: Distance from nearest well---- Distance from fQqdafion Distance to nearest lot line---v............0. Number of lines---------j_7---------------------Length of each P-1-004_1-004 V/idth of french_______ r1 - ------------ Type of filter material__-S_t_>2.0_MX_Depth of filter material_-_--__tV'____--Total length--------------- Seepage Pit: Distance to nearest well-----(,(1'Q_........Distance from foundation-----1D'-_.__..Distance to nearest lot line____a�-.___._ Number of pits-------.2----------Lining mate ria l_Z.._12t2 I(Size: Diameter-------3c3--------Depth-------------- Sir Cesspool: Distance from nearest well------------------Distance from foundation----------------_-.Lining material__-_________-_--_-___-____________-. ❑ Size: Diameter-------------------------- -----------Dept h----------------- -----------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well - ----------_____ Distance from neave4f �uilding---- --------------------------- Distance __________ __-._.Distance to nearest lot line.----------------- ----- - - ---------- --- ---- ------ --- ----- ---- ---- - -- ----- --------- r i �. Remodeling and/or repairing (describe) ---- �-N-`5-j---A14---_---W%EW..-----tis-Y-`-STS-.m-+-------- ------------------------------------------------------•- (0 --------------------------------------------------------------------------------------------------------------------------------------------------_----------------------------------------------- ------------------------- -------------------------------------------------- ---------------------------------------------------------------- -------------- ---------------------------------- -------------------------------------------------- d -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Q 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 Joaq�iri Local Health Di4ricf. 1,� _--(Owner and/or Contractor) (Signed) ( ---- ------- -- - - - _ By:.--- ---- --------------------------------------I------------------------(Title)-------------------------------------------- ---- (Plot plan, showing size of lot, location p system in relation to wells, buil4ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.. _ __t_:; �- - ----------------------------------------- DATE--- ------------------------------ REVIEWED BY----- ----------------_---------- ----------------------------------------------------------------------- DATE-- ---- -------------------------------------------- BUILDING - -----BUILDING PERMIT ISSUED----------------: --------- --------- --------s ----------------------------------- DATE------ ------------------------------------------------------ Alterationsand/or recommendations:.-, -------------------------------------------------------------------------F------------------------------------------------------------------------ ------------------------------------------------------------------ ------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------_----------------_____________________________-------------_-----------------_--------------------------___________K---------------------------------------------------------_-_____-_____. _________________________________________________.----__---...__--___-------_._--.-__--_---__--__-___.__-.._-__-_-_-_____-_-____--_-____-___--_-r___-_______-_____.--__________________.--...__.__-__-_-.-__._______-_-_.. ---------------------------------------------------------..-_-_-___-__--_-----...-----------------.----------------------------------------------------------------------------.--------------...__--__--__________y---------- f FINAL INSPECTION BY:.� ,_�__.:___c� � ___...__ ____-_-_ Date_-.-�: ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 C.