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4a _________________________.._____-.:..____...___.._______ APPLICATION FOR SANITATION PERMIT Permit No. _9172 ------ --- -•------------- (Complete in Duplicate) --` --/ --- t `�7 ------------------------------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued 2-2q-24o_( 0 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 compliant with County Ordinance No. 54 . Esc ,31 JOB ADDRESS AND LOCATIO _SJ1�E--_--__ _ , ! y^I ! Owners Name -11�[. `---- RP------ ---- ---_.Phone------------------------------------ �j Address------------------- �_�-1-LI-r-z----------r�rD51 Contractor's Narne__Q.1j11 Phone_._.-_ .`i. � Installation will serve: Residence [r�Apartment House E] Commercial p Trailer Court ❑ Motel 's I 1 -' Number of living ____ Number of bedrooms _ units: __.tr ___ Number of baths —. Lot sizeI----__________._�j "(S AgWater Supply: Public system ❑ Communitysystem + {� y ❑ Private Depth to Water Table�_r�`_._ ft, haracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ay ❑ Adobe ❑ Hardpan e- .,�. ' ;: ;P , revious Application Made: (If yes,date-----------_--------) No New Construction: Yes Lg—No ❑ FHA/VA: Yes E�--No% ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted ,f public sewer is available within 200 feet.) V Septic Tank: Distance from nearest well--------- 0Distance(from.6undg4pQ--__.__.. p..Material_ o�VCJ E-Tim...__ No, of compartments.----- 2--Size_--- _ bo X i m �---- ---- - _Liquid depth_.._ __ --Capacity-9 Disposal Field: Distance from nearest well_ ___-5Q_{Distance from foundation___.____._.l ` D_.Distance to nearest lot line________ Z._----Length of each line_ _ Number of lines------------- -y- 'f#S-„-.Width of trench- ----- _ Type of filter material___ _�__Q N---_Depth of filter material___._____1 -- Total length Seepage if: Distance to nearest weli------IQ_Q--___Distance from foundation_______1-- QDi ____ stance to nearest lot J, Number of pits------;;�-------------Lining material---Rd-CK_-Size: Diameter.-_/e --%------- Depth.__L---------:---------------_ y Cesspool{: Distance from nearest well_________________Distance from foundation_.._----------•--..Lining material------------------ --------------- - ,r El Size: Diameter-----•------------------------ -- - Depth----------------. ---Liquid Capacity- �Prvy: Distance from nearest well _ __.___---.-Distance from nearest buildin - --- g,-------------------- -------------------- Distance to nearest lot line_________ --------------------------------------- R ” odelin � g and/or repairing (describe}: ___ ___ ____ ______ :_.---------- ------ ----- ------- --- ------ ----- --- -------------------------------- - --------------------- ----- ------- ---------- ----------------------------------------------------------------------__------------ 4 � �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) Y (Title)- ---- _'_--`.----`--`-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). '. ��FFO�RDEP�TM�ENTUSE ONLY , -APPLICATION ACCEPTED BY__ [_R _----------------------------- ------------ DATE--_- REVIEWED BY ----------------------- ------- ---------------- -------- DATE ;a&-. BUILDING PERMIT ISSUED--------------------------------------------- DATE ------------------- Alterations and/or recommendations:.__.Iz_-717-_`p-e--, ..fk© j ESs-----_ _r.__ tr =as " -- --------------------------------------- --------------------- a,, - ------------------------------------------------- ------------------------------------------------------------- -------------- u= ... F� OL FINAL°I INSPECTI ..... �� b ` �j Date --------------- -------- ------z -------------------- SAN JOAQUIN .LOCAL HEALTH DISTRICT . 1601 E.Ha:ellon Ave, - 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California. Lodi,California Manteca California � Tracy;California F.P.CO. �_ „� _ j