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ruK urrlc,l= uat:� �, ------------- ----'--------- --------------------------- ___________________-___-..--.--_.-.._-.-__-._-.. APPLICATION FOR SANITATION PERMIT Permit No. /� ._- ----------------------------- -------------------------- (Complete in Duplicate) ------------------------------------ --------------- This Permit Expires 1 Year From Date Issued Date Issued .0--yQ-0-50 --Q3 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,wi.th Count $Ordinance No. S49. C-se.�qLO SC7 JOB ADDRESS AND LOCATION--- =� R = - ---------- I2 � , r LST F _. Owner's Name-------- 13F?v ------------� - oc_ARA/-V------ ---------------------------- -- - -- -- P,one----------------------........ ••---- Address-----------193.L--------R N -------R.D_t------------------------------------------------------- Contractor`s Name___, P_VVkJ__d------5FRI--f-�-- ---5 --------------- Phone-------•- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ +' Number of living units: --I---- Number of bedrooms _._____ Number of baths __/___ Lot size ------ --______________________ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table- ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan 0 Previous Application Made: (If yes,date____________________} No New Construction: Yes E�'No ❑ FHA/VA: Yes ZT-l" No ❑ TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:. Distance from nearest well___5Q-___Distance from foundation----r!0----------M trial---GOING-RF—T _------ No. of compartments-------_—-------_.__Size__ 1Q_X_tT-___Liquid depth_-_ 2 .......Capacity___/zw_ Disposal Field: Distance from nearest well__S ----_Distance from foundation..__l0______-Distance to nearest lot line_____. Number of lines------------"x�__. Length of each line__ �� -�— -3LWi { --------- 9 ��------ -- Width of trench-._.�-.�,---"----- ----------- Type - ---- -- Type of filter material---��p_�-��----Depth of filter materiaL___.__�_`�____.-__.-Total length------------��_ _____________ Seepage Pit: Distance to nearest well------_------_--------Distance from foundation__________________.Distance to nearest lot line-______-_________ ❑ Number of pits----------------------Lining material-------------------.---Size: Diameter-------------.---_---Dept h------:----_--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__.-------_---------Lining material__-_______.-____-.-.___--___________ ❑ Size: Diameter-------------- - ---Depth----------------------------------------------------Liquid Capacity---------------------------gals. Priv Distance from nearest well---_-----_------ _-__-_Distance from nearest buildingf ❑ Distance to nearest lot line---------------------------------- ------------ -------------------------------------------------------------------------------------------- Remodelingand/or repairing {describe):------------------------------------------------------------------------------------------------------------------•----------•------------ -------------------------------------------------------------- Tri 1 "� L_1%44 s- _ <a i"M E-b CA� --------- � ----------------- H ----vas---------rF/ I hereby certify that I have prepared this application and +hat 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. -Ft R_0 ---------------------------- (Signed)---------------- - --- --------- - ------ - -- - ---------- - - - ---------------- weer and/or ontractor) ..._. y..w. ------ _ ~_ --------------- --------------------------`------------------------- ----------='=-==------------------------`--------------- ---- ------ -------- --- - •ate ...��..: (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------------------------------------ DATE--------- fs-��y------------ REVIEWEDBY--------------------------------------- ---L------------------------=------------------------ ----------- ----------- DATE-------- --- ----------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------___-------------------- ------------• DATE-------------------------------------------- --------------- Alterations and/or recommendations------ ------- ------ ---------------------------------------------------------- --------------------------------------------------------------------------- --- ------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- -------------- ---------- --------------------------•-------------------------------------- ------------------------------------------------------------------------------ --------------------------- --------------------- ------ ------------------ ----- .............. -------------------------- ------------- --------- ---------- ='---------- -- ----------------------------------------------------------------------------- - -- - ----------------------------- FINAL INSPECTIOI�I �� --- -- - � -- Date � < ----- -------------------------------------- SAN ------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California