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FOROFTICE U4E: _ __________ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . `�1- __ (Complete in Duplicate) r Date Issued ____ This Permit Expires 1 Year From ,ate Issued 2-0S- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .t 2$ AE FSC JOB ADDRESS AND LOCATION---------_�1 Y�---A Lam. {------ --- ------F_NP-------y_!:_v_ _1\I t ^---------------- Owner's Name-------------R-o_13_F=_RT-------!'lQ-clla------------------------------------------------------------ ---------------- Phone__ --21-M�--1---- Address------------------------F ap--------�`a----------��--------S-il --------jCLO ..j..-- nn Contractor's Name--------T:. -�}� � 1 :..-. INC-- ------------------------------------- ------- �/------ Phone.-Yu!---/ k7_ Installation will serve: Residence LEI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms __tea_ Number of baths 27_ Lot size _�A_C_h.1=lg_4 _____________________________ Water Supply: Public system ❑ Community system El Private ❑- Depth to Water Table Z.p it, Character of soil to a depth of 3 feet: Sand ❑ Gravel n Sandy Loam MClay Loam ❑ Clay ❑ Adobe ❑ Hardpan �- Previous Application Made: (If yes,date--------------------] No 121�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_________________Distance from foundation--------------------Material------------------------------------------------- - C)U3-11 dCo- No. of compartments------ -------------------Size--------------------------------Liquid depth---------- ---------------Capacity...--------- -- --- t Disposal Field: Distance from nearest well_________________Distance from foundation__________--___....Distance to nearest lot line----------------- � r--K)-5T I�(C-� Number of lines-----------------------------------Length of each lire------------------------------Width of trench----------------------------------- Type of filter material-------------------- ---Depth of filter material-----------------__---Total length------------------------------------------ Seepage ____________________ _______.______.____Seepage it: Distance to nearest well-----1UC-------Distance from foundation______/_�____.-.Distance to nearest lot line.____ ___-._. Number of pits------/--------------Lining material -,860<Size: Diameter-------'16'__- ----Depth-------- -----------. Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material___._.._---_______.____.__._________. ❑ Size: Diameter--------------------------- ----- ----Depth.---------------------------------------------------Liquid Capacity----------------------------gals. ~ ' Privy: Distance from.-nearest:well___.�--------------------------------------------Distance from nearest building------------------------------..__-----. ' ❑ Distance to nearest lot line ....... .—--------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------- _17P)-T1P-A------_-1--Q-- -=Kl_:?-1_!_ _ ----- - Tl =----- -- 1--,- r� 111_� 7�l� - 1� = --------------------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- 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) ----------------- -------------------------------------------------------------------------}Owner and/or Contractor) By:------------------_-----------=- ---C-.---- 5 ------------- _-t ----------[rtlel '----------- --- -------- ----- ------ -------- (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--- ---7TR --------_-------------- DATE------- _GS_- ------------------ REVIEWEDBY---------------------------------- ---- --------------------------------------------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------- -------------------------------------------------------------------._ DATE----------------------------- - ---------------------------- Alterations and/or recommendations:------PLT ......P.6 .L4--------- -----.� __`..10------ ---5 &.p- --------R --------------------------------------------- ---------------------- --------------------------------------------------------------------------------------------------------------------------------------•---------- ---------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------i-------------- FINAL INSP CII--- --- -- ---- Date---- -------------- ..... ..1----- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.ffaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.cn.