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FOR OFFICE USE: T s __.____.____________ ______ _ APPLICATION FOR SANITATION PERMIT Permit No. .--1.7.9.f /�. --- --- ----------- t� --- ----- (Complete in Duplicate) - Date Issued --- ------------------------------------ --__-_---__--___. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d scribed. This application is made a in compliance with County Ordinance No. 549. N 4°V sruE c Q , � / p JOB ADDRESS AND LOCATION---- ---- / ST1 oC1. QF Yom- 1.PC' -------_R Owner's Name-------------D---- NR��=-------�'IUNa .-- --,: --------€ Phone-------------------------------------•--------- ----------------------- Address-----------------------L1_T-1=........--------------.�P — C -- Contractor's Name___ ................._______.. _F ----- Phone----------------------------------- Installation -.Installation will serve: Residence 0'Apartment House Q Commercial ❑ Trailer Court ❑ _. ?Iotel ❑ Other ❑ Number of living units: ----- Number of bedrooms _ Number of baths __/-_- Lot size _________________________ ❑ Water Supply: Public system ❑ Community system ' 'Private f/ Depth to Water Table �i27__ ft. Character of soil to a depth of 3 feet: Sand [Gravel 0 Sandy Loam R` Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------- N©' New Construction: Yes ��K10 E] FHA/VA: Yes ❑ No P5' YOR 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-----------------Distance from foundation--------------------Material---_____-_______--.--__-__-_-____--.-.--___-----. F_ N G No. of compartments------------- ------------Size------ ------Liquid depth--------- ---------------Capacity---------------------- Disposal Field: Distance fr%n nearest well .,5_ .._Distance from foundation..10-_------.Distance to nearest lot line._-______.._ ��T11046- Number of lines- __-_ -. _ -.-Length 6p! A f each line__� -_!> -_Width of trench_ _zt,F i ------- --------� Type of filter material__90_-CK-_____Depth of filter material _l7_ .......Total lenge)"___./✓---------- Seepage Pit: Distance to`nearest well _:_.:'__Distance from foundation--------------- Distance to nearest lot line_________________ ❑ Number of pits-----------_---- -_ Liiring:Material_-__ _-..--__.-_Size: Diameter-----------------------Depth-------------------------------.- X� Cesspool: Distance from nearest well------------ ---.Distance Trom foundation--------------------Lining,material_---_ -_ __. ----------------- ---- -__-___-__--__ ❑ Size: Diameter bepth -------Liquid Capacity -----•-- ---------gals. N Privy: Distance frim nearest well--------------------------------- --------Distance_rrg4 rnj pOest building______ ___------------------------------- Distance _ ____ _________ __________Distance to nearest lot line.------------------------------ ----------------------------- ---------- ----- --------------------------------------------- Remodeling --- ----- --- ---- ------ -------Remodeling and/or repairing (describe)-------------------------- --------------------- ------------= ------------------------------------------------------------------- - - .. ---------------------------- ---------------------•--------------------------------------•-- ----------- -------------------•-------------------------------------------------------•------------------- ? , �. ---------- ------ ---- ----------- ---------------------------------- -�. --- - ------- ---------•------- ------------ ------------------------------------------------•---------------- 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 an4 regulations of the an Joaquin Local Health District (Sinned) ------------------`----- -----------------------------------------" - - ----- - -------(Owner and/or Contractor) C .gZ By:------------------------ -------------- ----------- -----t[;)----- ----- -- ------------------- -- - -- ----- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----Tr<.-Rto------------------------------------------------------------------------ DATE--------- = ------ REVIEWEDBY----------------------------------------------------- ------------------------------------------------------------------------ DATE--------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------- ---------- Alterationsand/or recommendations:--...............----------------------------------------------------------------------------------------------•...---•-----------.....-----------•---------•- . ---------- ----- ------- ------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------•-------- -----P FINAL INSPECTI Date - -61 6 -----;----------------------------- 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.C 0.