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FOR OFFICE USE: ry --- ----------------------------------- *.MoaJ ------------ ---------b--. --.____ -. --------------- APPLICATION FOR SANITATION PERMIT Permit No. ..../ - ---- (Complete in Duplicate) Issued � --------------- �� "�" This'Permit .Ex ices 9 Year From Data ssue Date Issued ,lel 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. JOB ADDRESS AND LOCATION-------- ----- 93--..Bei„vel,_ere.....S 0kt0n__-t Ca ju f.-----------•-----------------------•-----------� Owner's Name MX'8. $ F •---------------------------- ---------------- . � --- --------------------------- -----j--------------- Phone..-----•----•------- -• - ! Address-----• -----------•-•-•Ab - -----o--gE R Contractor's Name...... ...........•----F--- --------------- Phone_-Hqit..-_3"12E7g --- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [:1 Other ❑ Number of living units: �- Number of bedrooms ..-1__ Number of baths ----I- Lot;size .6Q_!..- -X-E-120.fir- Water Supply: Public istem [J City system El isDepth to 1Nater Table - t. � yommun Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Ciay Loa ❑ Clay ❑ Adobe ® Hadpan ❑ yy . Previous Application M�de: (If yes,dote------------- No a New Construction: Yes ❑ No ® FHA/VA: Yes ❑I No 91 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feet.) Septic Tank: Distance from .nearest welt-----------------Distance from foundation-----.--------.----Material--..----_--_----_---.-----.__-----._ ---__-_---. EXIsUng No! of compartments---------------------- Size ------------------- ---=---Liquid dep�h--�-----------------------Capacity---- ' -- Disposal Field: Distance from nearest well-.-.- -_.-_-.:Distance from foundation----__---------------- _....Distance to nearest lot line_'--------------- Q Ex I S Ung Number of lines-----------------------------------. Length of L ac,h line--------------------- of trench-------._-- --- --- Type of filter material,al•_ --- -.:.- -- -Depth ofIte�material _ otal length ------------------------ ------------ Seepage ---:.- - ------------ ] - ,--- ,--_-.-----.-- Seep ge Pit: Distance to nearestwell_-----i20ne----Distnce from foundationQfDistnce to nearest lot line Nber of pits---------1 k fX-�__.. ---------- g a__--- ----.- ze: iameter--_3 -.-- .--.- . G4 Cesspool: DiJance from nearest well------------------Distance from foundation--._--------- .-_. " ' i A ming material ---I-------•--- ❑ Saxe: Diameter----------------- ----- --------•----`Depth---------------------------•------------------ iquid Capacity-------------------1-------gals. Priv r y:: Distance from nearest well-----=-----------------------___----- est buildingI Distance from neatest — ❑ Distance to nearest lot"line -•-------------------------------------••-- Remodeling and/or repairing (describe:_-A3 ink Filter-bE3•-fig.--- - -------------------- -----------------• t. ---- ----------. - ex- -lyat-am._•--------------------------•- =------------------------------------------`----- _ -------- --------------- ----------------------------- ------------ --------------------------------- F --- -- - .-1 I hereby certify that I have prep";4this appfic fion'and that the work will be done i accordance''With`Sari Joaquin County ordinances, State laws, and rules and regulations -of the San Joaquin Local Health District) (Signed)-----_ Delia kn_c - ---- r - ---------------(Owner and/or Cari'+ractor) Per 4 ar'r;han i - - -----------------� �---. By:.-:------- f --a = (Title); ) Gem. Mgr.-------- (Plot plan, showing size ofo,_1#Flotation of system in relation to wells, buildings, etc., can be placed on rev�ei•µeside). V. FOR DEPARTMENT USE ONVr APPL1CATlON ACCEPTED BY-- ?"" r z DATE-------1� REVIEWED BY lr�._. --------------------------------------------------------- ------ QATE' ..- BUILDING PERMIT ISSUED - 1 - - - - ------ DATE------ Alterations and/or recom --------- - enda ons:4::_ - _ " "Z....--=--- -- -•----=-------------- - •--------•- , _ , - ---=- --- - - --- - k / ...�.. - -----;---------------------------------;-_------------:----._- --------------- --------------------- --------------------------------------------- -_-------------------- ---------------------- FINAL INSPECTION BY -.--- - �• �-P% - '" d . SAN JOAQUIN LOCAL HEALTH DISTRICT (&730 South American Sheet / 3G0 �esl Oak.Streot - i'Z i - 124 sydil_re street 205 West'%t Stree, Stockton,California l�S Lodi,California Manteca,CaliforniaTracy,California E8.9 REVIHEp a-59{•p.00.2l'.,6-60 // S�