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FOR QFFICE USE: ; r _ ' = APPLICATION FOR SANITATION PERMIT Permit No._,Zxz//Y�•- (Complete in Duplicate)a �! ---------- -------- --- This Permit Ex ices 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hel ' described, This application is made in compliance with County Ordinance No. 549. 51 DR R SC��af� JOB ADDRESS AND LOCA 10 .----_-- -------------------- ----------------- ..---�- Owner's Name-:_---._-__-_-�f17-�-L1_Ca _ ! r�Rp `-------------------`--�_h- - ------------- .- Phone - ------ -- -- Address----------• - T Contractor's Name------------OSA NEIZ: -. ; •-- ---------------------------------------•- ----- ------•:-::,Phone,�.---•---•------------••------. Installation will serve: Residence 93-'partme ouse Com?nercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: _-I--- Number of`bed,roo s _-3- tuber of baths - -__ Lot size _--_ -'!� /_ -�- Water Supply: Public system ❑ Community sysFem. rivate Depth to Water Table3��ft. Character of soil to a depth of 3 feet: Sand'❑ Gravel ❑ Sandy Loam ❑ Clay Loam Zr"Clay ❑ Adobe ❑ Hardpan . Previous Application Made: '(If yes,doTe-__:.--- --- No 1 ( New Construction: Yes �No ❑ FHA/VA: Yes ❑ No[� TYPE SOF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted 'i f,'pubiic_`sewer<is-available within X00°feet.}- - -.-, - - P t -� �. Se tic Tank: Distance from nearest well!_��7_-_�Distance•from-foundation-_--- -_ �.[ .. Ma#enaI PAL b9 ---- NC-)k�T_Z L•1 No. of compartments- - _- _-__Size-_ X-1-a.X_�. Li uid cue th---- p - r q P. 1 CaPaci � - Disposal Field: Distance from nearest welly 5'Z�_-___Distance from foundation-_-10 -- .-----Distance to nearest lot line_________________• Number of lines-------- ---- Length of each line-_-- -_-_ g -.Width of trench . --� ___ t Type of filter materia- Q-C- __--De th,of filter maferial_-.__ ' + s p ----�.........- Tota€ length-__._1�-� �`�___ ---� . Seeps Pit: Distance to nearest well MAI from foundation_ S~ Distance to.nearest lot I nel,7___- f ( Number of pits__ _-------- .-Lining r ._. material:�Q_[ ___---Size: Diameter..5'_k.__ ___ _ Depth".._-..�1__----.�_�'r�11 Cesspool: Distance from nearest well "`__:------ Distance from foundation--------------------Lining material--. ❑ Size: Diameter---------------------- ---------Depth--------------------- ---------------- -----------Liquid Capacity gals. Priv Privy: �.Distance,from nearest well-t-1.----------------------------- -Distance from nearest building ,. ----- ----- istante to nearest lot line_---___-_ -------- --------- ----------------------- Remodeling and/or repairing (desceibe)------------ - - -- - ------ -------- - 4__.--.r_- _..-,r'Y-------e -__-_-----__-------------------- -_--------- f rr�'..i ;a tq y r --------------- -------may --------- ---------------------------------- ; , r" i,ra y-+��1,y ----- ----------------- - ---••--- I herebycertifythat 1',have prepared this application and that the work will A ordinances, State laws, and rules and regulations of the San Joaquin Local Health D l P P Ppbe-donein accordance with San Joaquin County , isfrict� Si ned '.� � - � �. { }g i - ------------------ --------(Owner and/or Contractor) ------------------------ --------------=- By:-------•------------' - {Title} ---- -- - -` -- ------------------------------------ -- p _�,.. (Plot plan, showing size of lot, location of.system in relation to wells buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ,- -,-Q------------------------------ ------------ --- -- DATE-- REVIEWED BY--- - ----------------- - --- ------��_`:-�..-`-�-, }- L- L? 'Q------------------------------------------------------- DATES BUILDING-PERMl7 ISSUED---•-• ------ •-- ---- -- -. DATE.-= -��_ ==�- �..,_:.- Alterations and/or recommendations------------------------ - , - -------` ------------ •---•------- ---------------------------------------------- ----------- - '- - A---------------- -------------------------- ----•---------• ---------------------•-- fir --y---------------------------- -----------------------------------------------------i------------------------ i ------ �- . 1LLDataFINAL INSPECTR BY:-. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ava• 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California -Tracy,California ES 9 REVISED e•59 3M 3-•63 F.P.CD.