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,UKUFI-lu USt: %! y a ------------------------------------------ ________________________________________--_-----_..__._- APPLICATION FOR SANITATION PERMIT Permit No. -- --------------------------------------- (Complefe in Duplicate) --...--- This permit Ex fres 1 Year From Date Issued' Date Issued __E!__-_�.-:"-"' 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 coma ce with County Ordinance No. 549. FECAL JOB ADDRESS AND LOCATI ------11 V.. ----eE--------�; XTQ Owner's Name----___1 �1_r—mopu HP,01-- E_ Phone. ----- Address--------------`-�--o)- Contractor's Name----C19RLC t_- -------------- �r-- 1-C �' l Z0------ �r 4� )----------- Phone Installation will serve: Residence E] Apartmenf'House. Commercial ❑ Trailer Court ElMotel [IOther Number of living units: _--- Number of bedrooms ---- Number of baths ____ Lot size -----#GR_F--►4__6EJF_ _ ----•----------- Water Supply: Public system ❑ Community system ❑, Private &'Depth to Water Table Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam [/Clay Loam ❑ =Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_...................1 No 21"" New Construction: Yes ❑ No 2`_F_HA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: t . , r --�- �.-;...(No-sepfic..tanVor cesspool permiffedAf•public-sewer-is-available=within 200-feef.) �'�""' • Septic Tank: Distance from nearest well_________________Distance from foundation--------------_-----Material__.______..____.__..__ - E [ T!nIC— No. of compartments r Size-------------- Liquid depth Capacity V i _ Disposal Field: Distance from nearest welf__./0Q___._Distance from foundation_--- --_Distance-Distance to nearest lot line�____._____ S D AJ C% Number of lines-_-----.--1-----------------------Length of each line r-----/u_ Width of trench------- - ----- 1p � .. w e f�,it#er mai erial-- -- 0 DD�, _Depth of filter material-----Q__ ______Dotal le gt nearest sty �y Yp �► R _... Number-of its- st well___--/-_-- Distance from foundation__ rest lot. See age Pit: Distance to neare rte' + P .rV .yi.ing materiaLP.C __...Size: Diameterh ._Depth I , ._.._ Cesspool: Distance from nearest well_____-__._____Distance from foundation--------- --=-------Lining material___-._____-__.____.____-___ ._ .� -----.Depth---------°-- y:....: :-'Liquid Capacity- --------------------------gals. ❑' Size: Diameter-- € Privy: Distance from nearest well___}______________________ .___._._-Distance4rom•nearest-buildingr�__.__-__- ❑ Distance to nearest lot line____________________-_________...---.--._____•----_---__ Remodeling and/or repairing (describe)_______ _ ____----__ Ik * � i ___________._____._ --------------------------------------------------------------- -----'-°`----------------------------------- 1< ( f i -----------•---------- ------------------------------------------------------------------- -------------------------- I hereby certify that I have prepared this application and that the work will'6e done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- .------- ------ ------------- ------- {Owner and/or Contractor) --- ----- _------ - - - (Plot plan, showing size-of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------ ---------- -------------------------------- DATE----- REVIEWED BY------------------------------ - -- --- ----- --- --------------------------- DATE---------------------- ------------------------------------ UILDING PERMIT ISSUED-------------------------- - ---- DATE.----.---------------------- ---------------- A teretions and/or recommendations:''__^-"� .~ - -•• -- ---------------- ----------------------------------------------------- -----------— r -------------------------------------------- - s ."1 ------------------ - -------------•-- —--------—--------------------------------------------•-------•-------------—-------------------------- ------ ------------------- -------------- — ------------- ---------- FINAL INSPECTI / _ ---- --- -- Date----------J___---2 � 1, SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,lfoxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s Stockton,California Lodi,California Manteca,California Tracy,California a F.P.Q C3. - �• Fi