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APPLICATION FOR SANITATION PERMIT Permit No. 44:57 ------------- 'a (Complete in Duplicate) Date Issued 3C19a f�&,K-f--- 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 complia' nce with County Ordinance No. 549. I - .1 JOB ADDRESS AN LOCATION-- ----/0-57--------- Owner's Name--------j a M�F—s.........6�fl K-0-U F—------------------- ------------------------------ --------- Phone------------------------------------ Address---------------1.21!4+---------- ----------------------------- Contractor's Name--------------- SMix----------------------------------- ----------------- Phone--------i---------------------- - Installation hone--------i-------------------------- Installation will serve: Residence 14?00'Apartment House E] Commercial E]!- Trailer Court ❑ Motel [:] Other ❑ Number of living units: ----- Number of b'edrooms --------*Number of baths __.Lot size -----------I--------------------►i--------------------------- Water Supply: Public system et Community systeE El Private R Depth, to Water Table -------- ft. Character of oil to a depth of 3 feet: Sand E]. Gravel E] Sandy Loam E],' Clay Loam E] Cay ❑ Adobe ❑ Hardpan 11_ I F-1 El 0 IN Previous Application Made: Yes Fii] No E] New Construction: Yes 0 No [-I FHA/VA: Yes D No E-] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool'permiffed if public sewer is available within 200 Septic Tank: Distance from;nearest we+�-------Distance from founda"tion""9'gliO�-----.MateriaI------------------------------------ ------------ 1 No. of compartments__.__------------------W--%--Siie—.----------------------------Liquid 'llepth-------------------------Capacity___-.------------------ Disposal Field: Distance from�nearest from founclation.l!v---------bi1S1ta�n-c;11t6*n-ea"rest lot line--- Number of lines_ ----------Length ---------- -------- of each line---- Width of french. -Z��;- ------------------ Type of filter rnaferial%31714---T4C$Qepth of filter materi'al-------20........Total length---------IT-U--------------------------- Seepage Pit: Distance to nearest Distance from foundation_-_-.Distance Distance to nearest lot line-AW-- Number of pits-_________________-_Lining material-----------------------Size: Diameter-----------------------Depth_-______________----_--_______- \ Cesspool: Distance frorri nearest well-----------------Distance from foundation----- 7---Liningmaterial------------------------------❑ --------- S Size: Diameter-_---.._ ___ "77TIJ—,pf h---------------------------------------------_.-_--Liquid Capacity----------------------------gals. Privy: Distance frome nearest well----------------I------I----------------------.--Distance from nearest building__-__ ________-___-__--_--_.-.-- ❑ uilding------------------------------------------ El Distance to nearest lot line--------------------------------------------------------------•------------------- 4 I Remodeling -----------------------------Remodeling and/or repairing (describe):____-_-___.__-______-___ -----------------------I---------------------—---------------------------------------- --------------------------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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- r) By:------------------------- ------------------------- ----------- -----------------------------------------------------------------(Title)-------------------------------------------------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings,'etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------'-TZ- Xt0------- --------------------------- ------------------------------------- DATE--------1&711'-5.'" �V---------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------- ----------------- DATE------------------------------------ BUILDING PERMIT ISSUED-----------------------------------------------------------------------------------!------------------- DATE------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------7----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- -:-------------------------------•----------------------------•-- ----------- ------------------------------------------------------------------------------ ---------------------------------------------------- -----------------I-------------------------------------- - --- -------------------- ----- ------ ------ ----------------------------------------------I----------------------------------------------------------- ---------------------------------- ------------ --------- ------------------------ ----- ---- ------ -- ------------------------------- -------------------------------------------------------------------------- Date-----------3-0� If- FINAL INSPECTIO -------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South.American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street - Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P-CO. 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