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FOR OFFICE U-SE:. --------------------- APPLICATION FOR SANITATION PERMIT Permit No. 52�1 ------------------ ---------------- ------------- ------------------ t-0 ----------------- {Complete in Duplicate) /7 ------------------ --- ---- --- -------- This Permit Expires 1 Year From Date Issued Date Issued 62,0-1_3 ; App[icafion 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. c Aq Lo JQ 71q, S_ A-UE-� 1 3 ,= 4 ' D LqCATIO� P . --------- ---------------- JOB ADDRESS AND -------R _1 -1� 16F......F-9s7C-------!---7----P�-- ------------------- -------- Phone------------------------------------ Owner's Name----•------- J-04M------ .......... Address----.....-. -----------1.6 ------------- -------------------------------------------------__-------------------------I------ Contractor's Name-------j0W__N__E_KZ------------------------------------- ---------------- - -------------------------=-----------------. Phone---------------------------------- Installation will serve: Residence [aZApartmenf House 0 Commercial E]. Trailer Court E] Motel 0' Other E] -------------- Number of living units; --)--- Number of bedrooms Number of-baths -------- Lot size Water Supply: Public system E] Community system,,O Private IB/Depth to Water Table .�57-4. Character of soil to a depth of 3 fee+: Sand Gravel 0 Sandy Loam 0 Clay Loam'[] Clay E] Adobe ❑ Hardpan 1. Previous Application Made: .(If yes,dote--------------------1 No E�I�el Construction: Yes E] No [} FHA/VA: Yes D No Rj�j� TYPE OF INSTALLATION AND SPECIFICATIONS- "(No septic tank or cesspool-Fr M`iffed if public sewer i"V`diIa616`wifhi�n-200 e Septic Tank: Distance from nearest well--------------__Distance from foundation____---_----:---_-Material---.---_--.----.---.__-__.________._-_-_-._-.-_. ----------- _qS—1-1 t No. of compartments--------------------------Size-------------------------------Liquid dep.th--------------------------Capacity--------- Disposal Field: Distance from nearest well.-.S!_---Distance from foundation----�O---------Distance to nearest lot line-_�>------------ Inff'r 14 Number of lines----_----{_______________________Length of each 1ine-----------2...S-------------------Width of french---_23 ----------------- `r�fit),1> Type of filter material Depth of filter material---h .--Total length-__--_-- ------------------- 29' i� Seepage Pif- Distance to nearest wel�-----6--------------Distance from foundation----/------- _____.Di,tance to nearest lot line__.��----------- zi�� Number of pits--------j....._ ----Lining material_&��X_,____ Size: Diameter.y---K6-----------Dept h----_ ---------------- � Cesspool: Distance from nearest well_________________Distance from foundation---------------- material-__._________- _---------._---_-_-!S- E-1 Size; Diameter.-----------------------------------Depth-------------------------- -- ------------------- Liquid Capacity- ------------- _:::-----gals. Privy: Distance from nearest well_____________________________________- -- __--..Distance from nearest building___-_____------- ---_--______-.-_--.--. '. ❑ Distance uildinq__---------------------------------------- Distanceto nearest lot line---------- ------------------------------- --------------------------------------------------------------- ---------------------------------- Remodeling and/or repair'm (describe)------6 -T-EM--------ST- RAT 1> ------W-171-400-T---------P.9 A�YliA-r—---------------------- Y`�,F__ _-T-6—---------------—FA -------------------------- --------------- ----------------------------P Rmor-_,-J --- -----------6---------(0/V _ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- - ------------------------ --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regglatVins of the San Joaquin Local Health District. (Signed)-------,!'- ----- ------ - ----------------------.{Owner and/or Contractor) ---- ------ ------------------ ---w----- ----------•----------------- - -------------------------------- -_ -------------- - (Tifle)---a-------- (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 _7 77 APPLICATION ACCEPTED BY--------7-'------ --------- ------------------------------------------------------------------- DATE -- DATE---------3------7�_— -------- -------------------------------- ------------- ----------------- ------------ ------- REVIEWED BY----------------------- -------------------------------- ------------------------ -- BUILDINGPERMIT ISSUED-------------------------------- -------------------=---------------------------- ----------- DATE--------- ---------------------------- ---------------- Alterationsand/or recommendations:------ --------------------- --------------------------------------- -------------------------------- -------------------------------------------- --------------------------------------- ---------•- •----------------------------------------- ------------ ------------------------------------------------ --------------------------------------------------------- ---------- -------------------------------------------- ---------•--------------------- --------------------- --------------------------------------------------------- ------------------------------------- i - ------------------- ------------- -------------------- ------------------------- ---- ----------- --------- ------------------------- - ---------------------7------ ------------------------ FINAL INSPECTi6 Date----------J A�1_ �L4'7-- - - ----------- --------------- ...... SAN JOAQUIN LOCAL HEALTH DISTRICT 116011.14ozeltan Ave. 300 West Oak Street k 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California L