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-------------------- -------------------- ! F1' ± ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. :-/. ...........!:2. ------ .........1_�--------------------------------------- (Complete in Duplicate) Date.Issued --- ____________________t:__ ------------------------------- This Permit ExEires I Year From Date Issued M. at 0 - -- h Application is hereby made to the San Joaquin Local Health District for a permit to construct and install e work herein descried. This application is made in compliance with County,.O 4 ,qdinance No. 549. o-rH Rof--' JOB ADDRESS AND, OCATION_ ------------ J----------- Owner's Name----------ALQ I R I W_-�_> -----------C--------- ------ ------------------------------------------------ ------- ------------ -------- Phone--------------------_--• ---------- Address------------------R-T-F------ -------_13 X-------- A T(i RfJT--------------------------- Contractor's Name---------------aWN.F5_f;*-------------------------------------------------------------------------------------------------------- Phone----------------------------------- *Y Installation will-serve: Residence -'-;kpartment House ❑ Commercial 0 Trailer Court E] Motel 0 Other E] Number of living units. A--. Number of bedrooms Number of baths I--- Lot size -------- C------------------ Wafer Supply: Public system E] Community system E] Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ®Gravel E] Sandy Loam E] Clay Loam'[:] Clay E] Adobe E] Hardpan D Previous Application Made: (If yes,date____________________1 No E] New Construction: Yes 2]--No ❑ FHA/VA: Yes E No E _ TYPE OF..INSTALLATION. AND SPECIFICATIONS:' i____� 1ra_ble �Yiih_i�_206 feet.) CONCIFZC-T Z--- No septic tank—or—cess —public sewer is ayai 7P Septic Tank: ' Distance from nearest well--- DisfancQ from founclaf ion----A2 Material-- ------------- ------------------------------- No. of compartments-------- ------.--Size--- 7Z-----------Capacity-Z-7-0-0. j. Disposal Fiefd: Distance from nearest well.__.-_-.-_---_Distance from foundation---/6_.�_-__,___.._Disfance to nearest lot line.�,_.:>--------- Number of lines---------- ----------- ----------Length of each lin-------- width of french........ ------------------- Type of filter Depth of filter material__..__I-1- ...Total length-----------1va-i' --------------- 6.1 Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lo,0ine---------------- ------ F-1 Number of pits----------------------Lining material------------------------Size: Diameter------------•----------Depth------ -- ----------------------- Cesspool: Distance ft'om nearest well_________________Distance from foundation--------------------Lining material_._.___,_-___--------------_________- -0 F1 Size: Diameter--- -------- --------------------Depth-.------------------------------ ------- -----------Liquid 'Capacity__---------- ---------..g6is. Privy: Distance from nearest well---------------------------------- ------- --Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line---------------------------------------------------------------------- ----------------------- --------------- ------------------ --------- Remodeling and/or repciring (describe):----------------------------------------------------------------------------I------------------ ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------7----------------- ----------------- - --------- ------------ ------------------------------------ -- -----------------------------------------------------------------------------------------------;-------------------------------- ---------------- ----`-y--'--------------------------------------------------------------------------------------------------------------------------------- - X---I--------------- ------ --- --- I hereby certifthat I have prepared this application and that the work will be done in accord' wiA San,Joaquin Count, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed]- -------------i24 --------C',,; ._------------------------------------------------------- �.A,_ Wner and/or Contractor -F4111 -------------- �BT------7-------------------------------------------------------------------- ------- --------- ------------ ------------------------ - ------ 0 x (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plaidn reverse sir FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--.- r_!_R:Z------------------------------------------------------------------------- DATE--------- = '. 5 - REVIEWED ATE---------- REVIEWEDBY------------- ------- -------------- --------- -----I------------------ ----------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------- Alterations and/or recommendations:---------------------------I------ --------------------------------------------I---------------------------------------------- -------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------11----------------------- -------------------------------------------------------------_------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------I----------------- --------- --- ------------------------------------------------------------------------- ----------------------------- ..........--- - ---- ------ --------- ------------- ---- -- ---------------- - ------ -- ------------------------------------------------- ------- -------- -------------------------------- FINAL INSP - ------- Date--.---- 26 -4�15 ------------------- ------_----------------- SAN JOAQUIN LOCAL HEALTH DIST.RICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycalmore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California V F.P.C Li.