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FOR OFFICE'US>& APPLICATION FOR SANITATION PERMIT Permit No. _R!_1_14�_4 --------------------------- --------------------------------- .(Complete-in Duplicate) 6. t .......... .............. This Permit Expires 1 Year From Date Issued Date Issued -___ 7�___ --------------- 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/--5-----l-- IzQ. 25ooy ; t /_ �sr�_nl } -- � f �r Owner's Name {-----------fl_�N_N.F_T}------- ---FE At_NE13AX-E�------------------------------------ ----- ------ Phone-----------------------•--------•--- Address---------- --^--- ------------MAN_rSC• ='_------------------------------------------------------- -----------------------------•-- Contractor's Name ----- ------------ --- --�ti----- ----- hone Installation will serve: Residence Apartment House ercial railer Cour LEl �te��s ❑ p ❑�x Comm sitar Court ❑ Motel ❑ Other ❑ r --.--- Number of bedrooms _------ Num i Number of living units: � bar of baths _..'..___ Lot size } Water Supply: Public system ❑ Community syste ❑T Private Depth to Water Table l0_ ft. _ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑,. Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_____________________) No,421"�'New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I 11 Y.. - 4 IL ..-(No.sepfic„tank--or�cesspool-permitted if-public sewer is 'available within; .200-feet.-) I Septic Tank: Distance from nearest we ___5 -- --Ditante from foundafi�n___/ ----------Material_O CK^~E— TA No. of compartments-------2 ----- ---'Size__ __ _K0_X_ ------------------ �- -• "`mt i 'v iquid depth_.5..................Capacity-_-lSoe�---- e Disposal Field: Distance from nearest well---S0_ Distance from foundation.-AP---.-----.Distance to nearest lot line----------------- j o Number of lines---------7-777 _ _._.__ Length of h line �� Width of length nc-- ----------------- Seepage -............ Type of filter materiaR`C.K�_DePhoffinemateria -------Total ------2�Q_--- ------ Seepageline I Pit: Distance to nearest well from foundation--__-_--------._--.Distance to nearest lot line--.--.--_-------- + - ^Cess❑ Number of pits----------------------Lining material-----------------------Size,Diameter-----------------------Depth-----.-.------------------------ 0— Cesspool: pool: Distance from nearest weft-----------------Distance from foundation_.----------------Lining material------------------------.----------r. �(�1 y 'Diameter-1--- El Size:'Diameter` ------------------ -------Depth----- ---------- ------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------- ---x_---- ----------------Distance from nearest building______.____________-----_-_---..-_----. ❑ Distance to nearest lot lin --------------------------------------------------------------------------------------------------------------------------------------- { WieRemodeling and/or re airing [desc 6EFt_C- ---- -Elf-1 OQl�'I --- " ---_--�R �7�------F4.QP .-_I>R .t 0stfl-dG------O -- --------- t>-, T_R_ fP--------- -------L3�-----057r,04Ez---------- 5-F Par ACg�.-------Al.__- AST---- If Im�------11?twrH_- - Q-R.......wrf F__N------/`E r -To-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, _ �G �. (Sign ed)- %w- ",�-'^-----±_--- --- 'E''"*--_ •�z`.�'`��w 4 - (Owner and/or Contractor) r -------- -------------- ----------------------- --------------------- - - "_ T (Title}. (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----I J?�0------- ----------------------------------------------------------- DATE------ -f+c 6�'---------------------- REVIEWEDBY------- ---------------------------------------------------------------------- ------- -------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ----------------- ----------------------------------------------- DATE-------------------------------- -------------- �. Alterationsand/or recommendations-------- ------------------- -------------------------------------------------------------------------------------------------------------------------------- li --------------------------------- ---------------------------- --------------------�-l -----------------•---- f` ----- ------------ ------- --------, ............ -------- ------ ------------ --------- ---- ------------ -------- ---- --- -------------------------------------------------------------- -------------------------- -------------------- QFINAL INSPECT] Date-- --- -----------2-------- .._...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California