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FOR OFFICE USE: - --------- ----- APPLICATION FOR SANITATION PERMIT. Permit No. ._: .v. -_.F - {.'. (Complete in;�Du;olicate] kf :Sr.S.E�€.J7 {-S "This Permit Expires 1 Year From Date Issued Date Issued -_.________.__ a- -- /�� - ?�.o -35 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 cam liance with County Ordinance No. 549. _�Aibed. ter' SF -'04. s2- -_.\ At JOB ADDRESS AND 1OCATION: _- __--_- -, _ ��. Owner's Name - ----- --- - - ---------- ---------------- - -- Phone�----=---------•---•----------- Address-----_--------- I --- •------------•------- ---------------I--------------............. Contractor's Name........QW?q'P!.T •-------- --•-------- ----------------------- -- Phone 11 Installation will serve: Residence ��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __ __._ Number of bedrooms l __- Number of baths _______ Lot size ----75 -------•--------------Water Supply: Public system unify system �' Priv`to ❑Depth to Water Table f_;74. Character of soil to a depth of-3 feet:-�--S6nd ❑•- Gravel ❑ Sandy-Loam�Cla Loam r Clay ❑, .Cl,y,❑ Adobe❑ Hardpan ❑ W Previous Application Made: (If y da e __._ _. } No New Construction: Yes®/f�lo'❑"•FHA/VA`Yes�E] NoTYPE-OF-INSTALLATION AND.�SP�CIFICATIONS: - ; � V1 (No septic tank or}cesspool permitted if public ewer is available within 200 feet.) � $eptic nk: Distance from nearest well e---____Distance from fouadation.___-If�_.___-.Materi i__RF-Pvr" _-.'------------ No. of compartments".__ ..______ ---Size___ _x_ X�.- i l g �} Liquid depth - -Capacity_/00.0_--•- Disposal Field: Distance from nearest.well-C ___._Dista from foundation_____/0---_-._.Distance to nearest lot li Number of; _---Len .� p icl of trench_ - ��--0 Type of filter matenal_R-�3�.�K--:_De th of filter mate' g ------------ . Seepage ` g e'a ne_ real----� --------- -Total len th--------------1�®----------------- �f ❑ Number of pits- Lining material_ - i See a e Pit: Distance to nearest well----------------------Distance from foundation---_____________ istance.to,nearest lot line-----.._._.______ p g F Size: Diameter - Depth ! i p F Cesspool: Distance from'nearest well---__-i-_--------Distance from found ... ation.___.:......... Lining material-_. _ ..________._.______ _. ❑ Size: Diameter ---------°---------De th---------------- -- ---- ------ -- Liquid Capacity-------------- -------------gals. t Privy: Distance from nearest well.--.__.______------ _ ----Distance from nearesfi building`----------------_-----------------------_. j ❑ Distance to nearest lot line______________'--.______. y - - ------- -------------------------------- ----------------------------•-- IF Remodeling and/or repairing (describe):----y---- --/ ------- R_Q Q _ ,��!4 8 ' , F_______________________________________________________________________ _ -----____._-___--._---_-_-__----._-____----__-_____-_--_-__-----_--____--.___---____-- -------.------_----------------- ------------ ---------------------------------------------•------------------------------------------------------------ ----------------- ---- ---- �( # t 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) ---"..."_" A. �_ T- -- _ _ a to Y• - --------- -------------------------------------------------: ---- ----- - - Ti#io-----------------�.�-.r and/or Contra orJ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR'D.EPARTMENT USE ONLY + A( PPLICATION ACCEPTED BY_A__-. -__f- .-0---------- --- -- DATE--------- REVIEWED " = '-66: BY = # --- --- --- •------- DATE----- ---------------- BUILDING PERMIT ISSUED ---- ----------------------------- -------------------------------------------- DATE------------------------------ Alterations and/or recommendations: = —.: - -- ------------_-=-------------==----------_'-'=------------== = f== �1-------- ------ 3C� `b --------5 _,�'r=7-------IYp ` = "' 1 `. ;il � - -- S`�"R:�'>- -� - ---M.R. ='�=--�A _�.---'T�__._CrlRN6E----. - v'� — - -_.'.---kj,?y,,e%,_r---� �:._I, 9Cf ------ 1 � �M > -------------0- --- = � R ---- IJt� ` . iv r ... ------0©2-------- �''--�—`� ------------------- ---------------------------------------- -------------------- -- ---- -- ----- - ------------ (FINAL (NSPate -T -_ 1--., r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lia:allon Ave. 4 340 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California l I ' d I F.P.0 C. v .� s�