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FOx OFFICE USE: ------------ -- --------------------- ---------------------------------------- - - -------------------___-___-_-._-----------------------------__- ------- APPLICATION FOR SANITATION PERMIT Permit No. .,;L.f_ ---------------------------------------- (Complete in Duplicafe) ---------------------------------- This Permit Expires 1 Year'FFom Date Issued 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. fV f JOB ADDRESS AND LOCATION _VIAE----- i�11�----------- __" ---- -I RRi L,TZ A ..----.RD,�-•----- ------ Owner's Name----------------- V_D----- Q_ _ .. ,r. Phone -------------- Address E-`-T�... ) L Contractor's Name---------214U 1 -E-R --- Phone----------------------------------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. -_ Number of bedrooms 5_- Number of baths Lot size .../ ?Q.. .-.1' -------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table35- ft. h� Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan w Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - - //�� Mate i I (-a/V+ ��TJ` Septic Tank: Distance from nearest well--- ..-....-Distance from foundation----�f --_- - No. of compartments__-.. ...........-Size �a.k---�.___Liquid depth. ... _.....Capacity.-,&._4?p_' Disposal Field: r Distance from nearest well..,?_-0-----4from foundation-__/Q____-__-Distance to nearest lot line--- '1 "'k 01.1" Number of lines-_-. __ men th o each ln -.-- `(....Width of trench___ 1---- _-f'�.�6 f -------- ---- g Type of filter material---R0.P',A' _..Depth of filter material-..-._- length---------.. ----- -7.a_. Seepage Distance to nearest well.-.--- -110--Distance from foundation----------- . .___.Distant ' to nearest lot line_.............._ It Number of pits----------- ----------Lining material.RP!�f-'S......Size: Diameter_Y-x... / _ Cesspool: Distance from nearest wail.................Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well......................._-.---._....-----------.-Distance from nearest buildi --------------------------------- ❑ Distance to nearest lot line ----------- ---__ x----- ------------------------------------------------------------------------- --------------------- Remodeling and/or repairing (describe):---J _ 1�.-... ----A.nj------Esn__ ( .sy� �------ _�-----139©R -------------------------------------------------- ---------AD-O -n-c��=------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed) - ----------- -------------------------------------------------------------------------------------------- ---------------------(Owner,and/or Contractor) By:---••------ ` - --------------------- -----------------------------------------------------------(Title}-----=---------- ------- - ---- = - (Plot plan, showing size of lot, location of system relation fo wells, buildings, etc., can be placed on reverse side). OR DEPA ENT USE ONLY APPLICATION ACCEPTED BY-------- 1 3 K --------------------------- ---------------------------------------- DATE------ --` f REVIEWEDBY-------------------------------------- -- ----- --------------- ----------- - ----- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- Alterations and/or recommendations:--------------------------------- -------------------------------------------=--------------••----------------------------------------.._..--- ---------------------------------------- -------- --- -- ---- --- --------------------------------------•-------------------- -------------------------- ----- ------------------------- -------------------------------------------- ----- --------- -------- ----- ---- -- --- ---- -------- f� --------------- ----------- ---------- --------------- ------------------------------------- FINAL INSP47 - Date... j SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California a��F Manteca,California Tracy,California F.P.r D.