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.v.vrsvrriL,t L1,,)t: - j APPLICATION FOR SANITATION PERMIT Permit No. -- ��'-- _..f��..f1�_ Z - ----------------------------- (Complete in Duplicate) ---------------- - This Permit Expires ] Year From Date issued Date Issued -_:___..__. .�...(p/ 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 compliarice,with County Ordinance No Y'549. J# p ct 2C�© JOB ADDRESS AND LOCATION" � QQ t � � * . - -'-------------450---:..QF....Nl_:_sr�---•---- i Owner:�s Namet�_ '� - � '"- - T�RQ-�---••---- a-x -C7 _ - �.:•,d ,Phone -. } :Address x tT _RdP-----------------•- 4= ..... - ' ' ------------------------------------------------------- .......... .Contractor's Name_-•----••----Q_�_��'�---•------------•------------------------------------------� t ---------•-- Ph Number of living-units:units: _ nI one.......................•_----__^••- Installation will serve: 'Residence [L�Apartment House ❑ Commercial raihe~r�C' •• � Q Motel ❑ Other ❑ t! 'w /�/} 9 u er of bedrooms _umber of hs'V---V-4 --_ Lot size /A04 __X_-•,� _--_ Water Supply: Public system Community system ❑ Private ❑ Depth t Water Tablv.6 tt. Character of soil to a depth of 3 feet: Sandravel ❑ Sand Loam o ®/Cla Loam 0 Clay[� Adobe❑ Hardpan ❑ � Y Previous Application Made: (If yes,date_�__________________) No New Constructron„; Yes o y=•--" -„__�_.r_�_s�i: ❑ FHA/VA: Yes ❑ No 4 TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tank or cesspool permi4ed if public sewer is avallablefiwithin 200�feet.} Septic Distance from nearest welt__"”` Distance from foundation--, A 1 1 Mat rial__ pQQ No. of compartments__-__--�--_-_-----_Size_t � Q p y a !• --Liquid depth ------ CQ} _ ar acct _.___ � l•. : Disposal f=ield: Distance from nearest well.."' -------.Distance from foundation___�� • Distant to nearest lot lme.____ Number of lines-A.---- - tt_. • 'J Length of each line_----- --------.___ Width of french-._._- {�•w Type of filter materia . : --+--�Q��_Depth of filter material__--_�. tl( N t � -- g-----------Totallength-----•------•--••---------•----------•-•-- h 'Seepage Pit: Distance to nearestwelDistan�foundation...... .............Dista nca to nearest lot line._____-___-_.__.. ❑ Number of Pits------_----------------Lining material.:___---__.______---.Size: Diameter__._____..___ k ----- --.Depth-------------------------------- Distance . :Cesspool: from nearest welL________________Distance from foundation--------------------Lining material_____------- - •---------... n ❑ Size: Diameter..---'! Depth -•---•----------•--------------- ---------Li Liquid Capacity_. - 9 ------------------------gals. Privy: Distance from nearest well___-__-__-----____ __-._.__Distance from nearest building g= --•----•--------------------- .. ❑ Distance to nearest lot line.______._--_------------------------------------ ---------•----- __________ Remodeling and/or repairing (describe)___________________ ----------------------------- ---- J�. _.c I�. ---------- ------ - ._ ' ____-_____ k --------------- -..._ ___. _ ___._______________________________________________________________..______________._--___...___-_____._._________._.__-_--______...______--._____-___-.________.._._--_____---__--_._-_--_-----_._ 'f 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. Si --- -- ----------------------------------(Owner and/or Contractor) _' i By:--------------------- -------•---- ----- ----------------------------------•---------------- - - - ------.[Title}------------------------------- (Plotw..�. W plan, showing size of lot, locatioWof system in relation to wells, buildings, etc., can be placed on reverse side). ,I f ; �! FOR DEPARTMENT USE ONLY APPLICATION � ACCEPTED BY. _.-._-._l�----- - !- - ----------- -- •DATE RrEVIEWED BY --*.�'----------------------•-------------•----------•------- ------------ ---------- i -- -------- ----- -------•-- -------------------------------------------- DATE BUILDING PERMIT ISSUED - ---'--'-- ----`---- - -------•-------------At catons=and/orirecommendations• ------ DATE-------------_-'------------------{--'- ---- ------ "=� -----_ IS ' --•----- i' i vj� ----------------------------•------------- ---------- .._._ ----------•--------- • ----------- ------- ---- ------ --- -- -- ------------------------- ------- ----- ----- ' .I FINAL�1INS. fO�1 _ _ r Date_-.- - rtl SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South America Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California.w EH-9 REyIBEo e•59 F.P.G[I.,L;MTracy,California �6.60