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' .FOR OFFICE USE:. _ -----------.f-- p APPLICATION FOR SANITATION PERMIT Permit No. _ -- --------------- -- --- - ------ ----------- --- ( oriripletiDuplicate)e n upc ]_ - --- CDate Issued �-� 6 --------------------------Z------- --" This Permit.Expires 1 Year From Date Issued 22� .. (q �fD—fes ; •Application is hereby made to the San Joaquin Local Healfh District for a`permit to construct and install the work herein described. �1 This application is made in compli ce with County Ordinance No..549. S V 14t�1 IRMTC 4 JOB ADDRESS AND LOCA olv 0�: A-lU DE-R._-�__.,�3o _ l-1�� r� &4E -- -' ?�'vf}Rn REX'. 4 ------------ Owner s Name-------------------- -�--------- ------ ---- ------------------ -- - -- ---- Phone.----------•-------.... Address--------------- ----••--i6 -'-------' x C 1 --••.------------------------•-----------------------------------------•-•------------ Contractor's Name-----O!'Mlk_( R_"----- - a ' ----------- - ------------ Phone.------------------- -- Installation will serve: Residence Apartment House ❑ Commercial• ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j-___ Number of bedrooms ..__ Number of baths -_`_ _ Lot size ----1175 x---R_60- ------ Wafer Supply: Public system ❑ Community system ❑} Private Depth to Water Table 10 ft. Character of soil to a depth of 3 fee+: Sand Gravel❑ Sandy Loam ❑j-Clay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ . . . Previous Application Made: (If yes,date---- } No New Construction: Yes E�-< ❑ FHA/VA: Yes 11" No ❑ TYP-E.-OF_INSTALLATION AND. SPECIFICATIONS:_.... M_ r.�. (No septic tank or cesspool permitted if public sewer is available within;200 feet.) rr Septic nk: Distance'from nearest`well-. Q2_..,.Distance from foundation_'_-10---------Mat ri I____- ---�T-�--__._. i No. of compartments-j �---- -----Size--- iYI A: Liquid depth.... _- ------Capacity__Io�pP-_-- Disposal Field_ : Distance from nearest weli__5o_----Distance from foundation'_ _ f_�_._�__.___.Distance to nearest lot linin { Number of lines_._.____ __ ____________ ____Length of each line-__f ,� Q__________.Width of.•trencli___.__. ---------- ,. f- k f. - --�. --- r---------- 1 Type of filter materia _ __Depth of filter material._._ ____.___Total length-._____.____ ______.________ 1 �QTIG- SOCK_ ' � i Seepage Pit: Distance to nearest well------ -------.____Distance from foundation--------------------Distance to nearest lot line_.____.___._---._ ❑ Number of pits----------------------Lining material-------------- -°Size: Diameter.-.--------------------Depth---------------------------------s ^11 Cesspool• Distance from nearest well-----------------Distance from foundation---------_----------Lining material------------------ ---------------- ---- __Li uid Capacity- ❑, Size: Diameter--------- ------- -"--------------Dept h--------------- -------- ------------- -- 9 ------------------------ gals. PrivDistance from nearest well_________________________________ Distance from nearest buildin y: :, 9 ----------- ---------- ❑ Distance to nearest lot line______________________________ --- l ' _ f y Remodeling and/or repairing (describe) ------------------------------ -----------------------------------•------------------------------------------------------------=-Y----------- I -- - -------------- ----------- is ------------------- -- - ---------------------------- ------------------------------------------------------------------------------- ------------ -------------------- ---------------: I hereby ce if at I v cepa this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat s, an u an r gulati ns of the San Joaquin Local Health District. _ t" R---------------- - IOwner and/or Contracfor) (Signed} --- ----f --z-- - -------------- (Plot plan, sho ing size of lot,.location of system in relation to wells, buildings, etc.,'can be placed on reverse side). �.M FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L --------�_R-a---------------------- ------------------------------------------- DATE---------_--' s.-66-------------- REVIEWEDBY------------------- ------------ ---------------------------------- ------•--- -----------------------------------------.--- DATE-------- ---•---•----------------------------------- BUILDINGPERMIT ISSUED------- ------ -------------------------•--------------------•-------------------- ------ ----------- DATE------------------------------------- ------ - -------------" Alterations and/or reco endations-------------------- -------------- -------------------------------•------•---------------•----------------`------------ z} Ta --��_5 --------- 1� T �- - --------- -------------------------------------------•-------- I --------------------------------------------------------------------------"---------------- ---------- - -------- - ----------------- - --------- --------------- --------- FINALINSPECTION BY------------------ --- ----------- ----------------------------- Date----- ----------- ----- ---- ---------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 340 West Oak Street 124 Sycamore Street 205 West 9th Street fff Stockton,California Lodi, California Manteca,California Tracy,California ` F.P.r o. i•t