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FOR OFFICE USE: X. 71 ------- -------------------- ----------------------------- ------------------ -------------------- ------ --------- APPLICATION FOR SANITATION PERMIT Permit No.; ---------•------------------------- ------------------- (Complete in Duplicate) ----------- --------------- - ----------------------__11-;j 11;1,i_:,jhs Permit Exioires"! Year From DatoAssued Date Issued J�-,2!;L4,5 24.- 0 q0-t Appkation is hereby made tojhe�`SahJoaquin Local Health District for a p6r'niif to construct and. install the wornherein de cr'ibed li�n' 'with-Courify Ordinance No. 549," This application.is made in_co6.p 031 -C.0 Cr-,4 loclfz_ 1 7 C ic)_ JOB ADDRESS AND LOCATI --OLE /3po------- -------- --- - -,AN ------------------------- Owner's Name Ax - R_--------- - --------- ----------------- ------------------- ------ ------- Phone------------------------------------ Address------------ Contractor's Name-------0-t4ftV.e ---------------------------------- - ------------------------ ------------------------- ------------ Phone----•----- ------------------------ Installation will serve: iResidence -1 .Tr' Apartment Hou Li Gommercial E] Trailer Court .[] Motel [I Other E] .-3-_--__' 3------ ---------- H 'mom --- Number of living units: ---/--- Number of bedrooms --- Numr of baths _ ____ Ltsize}. Water ply: Public system 0- Community system Sup' Privatejjj4,Deptfi to'Wafer,Table ft. Character of soil to a depth of 3 feet: Sand ravel Sandy Loam E] Clay Loam-El' -Gay�Ej--Adobe Ej Hardpan F-1 Previous Application Made: 9-wyes,date-----------;--------) No j4---'I�_ew Construction: Yes li;41 Ell FHA/VA: Yes F] No Er-'` TYPE OF INSTALLATION AND SPECIFICATIONS: c�r_.q_qsspool permiffed-if pu6lic.sewer_is.%vaila6le within 200.feet.) I Y4 Septic Tank: Distance from nearest weft..__, ___Di,tanf"e from foundaflon...../----------- K�c.ter',a 0 __0 Q> Si No. of compart ze q X-2 Capacity--- m . ........... X-57Li______Liquid dep�h-'-7-; Disposal Field: Distance from nearest well.-.5Q----Distance Distance from_foundation---t0_------..Distance to nearest lot 2rline---------------- 11 --Por J&Number of lines-F--------2--------_-__---...__Length of each line-W-- k7f?t_-Widfh of trench-----------------------:�� Type of filter ma I ferial-MROKEIV--Depth as 46DW --- --------Total length_-..___,.______I F 20 / Seepage Pit- DiL_fQ;iLe_f,61raeare sf well--------------_------Distance from foundation-------------J._Distance to nearest lot line-_.--.I . y - li,4' .-I❑ I W%k 0- I - ,L4n'ing-material_--- Diamef ------------ ----Depth- - ---------------------------- Size. ------ n'^,GessPod1t'AA t* Distance &m nearest well-----------------Distance from foundation_:.,__ :--_.-____.Linin material-.-.-_---------------------------- j Sib 0-r Diameter---! ------ --- -------Depth... ------ - ---------Liquid Ca`p'a-city__.--------------- T------ ------------------- ----------gal rk�y- Dist Ice from nearest well__...____-.-------_--_--------------------- - -----Distance from nBarest building"____...__---______----.- W11 DiWi ------------------------ nca,fo"nearest lot line-------------I-------------------I k"I F7 N Remodeling"and/or rep iring� (A O.W,i- irin (describe}:-_-."_ ----- ---------------- Se - -------------r ----- - ----------------------------------------------------------------------------- ------------------ -- ------------- -------------------------------- - ------------------ ------------------------------ ------ ------------------- ---------------------;�------------------I -- -- -------- - - --- --------------- ---- 1 ---------------- '1�I ----- -- ----- ---- ------ ------------ - ---------- -------------- - --------I hereby certify f a1t I hW;e prepared fl;4- ----- - ........ applicafion and that the work will be done in accordance with San Joaquin County ordinances, State 1law4N,__a'nd rules and regulations of tre 'San Joaquin Local Health District. A m ---------------- --------------------:---------Signea � �"�•• V( dB - - Z _ (OwnerI A/. or Contractor) Y: _---------------------- -- - ------ ------ l------------- ------------ -------------- -- (Tiflei--------------- -- --- --- - - ------- ------------- ------- _(PI otplan,`showing s14 of-ldt;Jdj�atj"n-'fsyst-6M-;-ijj'&Ia Sbuildings, can be-place&4 n- Ir tion fo-Vell , ? reverse-side),de);, FOW151EPARTMENT USE ONLY --------------- ----- -- ---1_____r------------- --- `7 ------------------- ------------ DATE-------- . ... APPLICATION AC.0 _7 ---- REVIEWED ---------------- _j --- I RY----------------- - --------- :77� ------------------------------ DATE ---k ---I BUILDING PERMIT ---- ,M------------------- --------------------------------------------------------------"-- DATE----------------------- Alterations'and/or recommendations:.----------- -------/ / — -A---------�4AXOU-7--------- ------------------------- -3<70,00-, -lktl - -- ------- ------------------------------------------ ------------ -----------------------1--------- ------------------ ------------- ----------- -------------I-------------------------- -------------- ------- -------------------------------------------------------I--- ------------ -------------------------------- --------------------------- ---------------- -- ------------------------------------------------------------ ---- -------- -- - ---------------------------- - ---------- `-`,4 ------ - ----------------- ---- ------ -------------------- - -- ------- ----------------- ----------------------------------------------- ------------------------------------------------ --- -- -- ------- FINAL INSPE-C Date-------------- ---------- -- ---------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California F.F.12-0.