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APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) �6 J Date Issued __-� -___-_��___ 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-------1& -----wo--------B . . 0 FfY---------------------------------------------------------------------------- Owner's Name------hl YK---------- ------------------------------- -------------------------------------------- -------- Phone--------------------------------•--- Address-------------------------------•-/&1M E -------------------r_- ------------------ - ----------------------------------------------------------------------.... ---------------------------------- Contractor's Name I - ------------------------------ --------.................. --- Phone------------------------- ------ Installation will serve: Residence Apartment House ❑ Commercialj:] Trailer Court.❑ Motel ❑ Other ❑ Number of living units: ��_____ Number of bedrooms ----- Number of baths.______ Lot size ____-________--__-__ Water Supply: Public system ❑ Community system ❑ Private I Depth to Water Table :______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El-2. 'Clay [] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No e New Construction: Yes 02-"_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 nk: Distance from nearest well!IP47-----Distance from foundation___ Q____-t_.Material----49NCKJE--T'F._----------- No, of compartments---------0 �---Size----------------------------------Liquid depth-------/_�___--------._Capacity------ QQ.... - Disposal Field: Distance from nearest well..%4d----Distance from foundation 10 -Distance to nearest lot linen______________ Number of lines_____________ --- - ------- -Length of each line_=_____ Q__:_-_________-Width of trench ____-_____ ----- � Type of filter materia _ ___- �4 __Depth of filter maternal_____ _e_____=_-Total length------_----_ Seepag Pit: Distance to nearest well__-.7Q-0:_ Distance from foundation___________________.Distance to nearest lot line_ --------------- - f. 1 Number of pits----_-.--I_-___-_--__Lining material_�� -f�Size: Diameter__�_��'__ _______Depth_____25_ ............_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________________. ` ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-----------------------------------------------__Distance from nea4st building-----------------------------------_----_. ❑ Distance to nearest lot line--------------------------------------------------------------------------------`` -------------------=------------------------------------- Remodeling and/or repairing (describe):---------- V-----------4:0�w -----.' -----34s--4---� -------- tT`--------- 9 ,---------------- --------------------------------------------:-------------------------- T09- `----- r-------- _c_4+.----------------------------------------------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here6 ertify hat I have prepared this plication and that the work will be done in accordance with San Joaquin County ordinances, tate•�, nds ndgula 'o of the San Joaquin Local Health District. Si ned{ g )------- --- - -- - ---- ---- ----- --- --- - - ------ ----------------------------------------------------------------- - --------(Owner and/or Contractors i gy=---------------------------------------------------- -------------------------------------------------------------------------------(Title)---------------------------------------------.------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---i--9 -V�------------------------------------------------------------------- DATE----- REVIEWED BY-------------=------------------- ----------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ------------------------------------------------------ Alterations and/or recommendations----------------------- ----------------------------------------------- -------- --------- ---- - ... - ----- -- - 7" p V-� -N-0-�--- -+- .. -�---- �l S �T{4� 5 '- c---- } -- -- ------- -- ---47� F-4--------- V - -------------- ----- - Date //FINAL INSPECT ---- --- ------------------------ SAN lI JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" S+ree+ Stock+on, California Lodi, California Manteca, California Tracy, California ES-9---2M , Revises 1.57 FRCO.