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FCR OFF1S-E USE: ----------------------- - ------- APPLICATION FOR SANITATION PERMIT Permit No. .... --- ------- ----------------- ------------------------- (Complete in Duplicate) ' Date Issued --- --------------------------- ---------- ----------- ..- --------------------------------------- This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. E E. i ADDRESS AND LOCATION/-::,.-2�-7---------- -- ��,--.;.: ►�.'7:;H-_---------�-= ---------------- ---�T�f��------------------------------------ JOBOwner's Name---------/II S's----- ..411VN Z------- V0-W=E-R0-------------------•-------#-------------------------- Phone 2 ��lT�-� �_ ------------------ Address----- 7----------- ti� --- - • -- ------- 0 Ph Contractor's Name-------1-��-'�------��1.�. ----S-�tr�-. 1:��.—�-s' _��--•--- -------------------------------------------- 6ne:�-----•----....--------- ---------- Installation will serve: Resident, []Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑" Other ❑ Number of living units: �_--- Number of bedrooms _5-- Number of baths � Lot size ---S-------0 j ..................... ---- 1 Water Supply. Public system ''Community system [I Private ❑Depth to Water Table .._ . ft. Character of soil to a depth of 3 feet:,,,,,Sandr�Gravel El Sandy Loam ❑ •y'Loam.❑ -Clay ❑--Adobe Lo Hardpan-E] 6q`1�D Previous Application Made: (lf yes,date-___.----_ _&&. .__.) No F1 New Construction: Yes 'o [:] FHVA/VA: Yes ❑ No [�� TYPE OF INSTALLATION AND SPECIF1CAT[OW s (No septic tank or cesspool permitted if public sewer is available1within 200 feet.) Septic Tank: Distance from nearest well--C-W-Distance fromyfoundation-. ,/0--_._.-.M��aterial---R�p VVQa>------- - �---------- Size. x _ Liquid depth----%'?----------Capacity-------H-Q-C�-'-•- No. of compartments______ _- �= Disposal Field: Distance from nearest well-..C,1111—Distance ro foundation.-..-/ ----Distance to nearest lot line-.,.5�_ Number of lines----------- .-- _.._..-Length of each line___....- 7��--Width of trench..___..., Type of filter material--Rp.Cj'-�L.-__Depth of filter materia7.............. length................13:e?_------------ Seepage'Pit; tVDistance to nearest well.__--_..............Distance from foundation_...-.-........_._.Distance to nearest lot line_.-.._....._.... ,. _J ❑ - Number of pits------------------ --Lining ma#e•r�l�__---_____-__---Size: Diameter.---------------_---- - Depth Cesspooh Distance from nearest well-----------_ODistance from foundation__.. _..._.__...Lining material---------------------------------- --- Size: Diameter----------- -aoo,!:`No"Depth--------------------------------- ------- ------Liquid Capacity---------------------------•9?Is.I n h Privy: Distance from nearest well�?t ---- ---------------------------------Distance from nearest.,!,Iouildinq-T-...__x__'_ :'"--------------- ----- ---------- Distance to nearest lot 1i42i------ ------ ---------------- -- -------------- --------•------ ---------- - f = Rn�-,. _ 10-7-0-------- .r D.--.--- - rr Remodeling and or repairing ('describe):. "�_-_,_ . _ _- _ -- To far � Zl ----- -5X ' --------------------- --- ------------------------------------------------------ -------•--------- -------------------------- k------------ ------------------------- `------------ -------------------- ------------------------------------------------------------------------------------------------------------------------------------ - ---- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws,'and rules re ulatlibris of the San Joaquin Local Health District. - - — t` ........... ....(Owner and/or Contractor) d 1/i' �--_. . ._ .°-- ----------------------------_..._---...Z -------------------------- (Signe ' " Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ �t FOR DEPARTMENT USE ONLY ' • DATE--- APPLICATION ACCEPTED BY...... -G' REVIEWEDBY - ' ---------- DATE------ ----------------------------•----------------------- Alterations and/or recommendations•.... DATE...................... BUILDING PERMIT ISSUED------------- ------ ----- -- ------- - _ 70..........A.DD-tri3OAj--------/N- Ca�b------- ] r� y � v.{. --------4------------------- -----------SD--------�'------� -------- t ------------- ------------------------------------- ---------- -------------------------- 4- ----------------.. --•----- ---------- -- - � . :_ _ _ ----------------------- --- ------- ----- -------------- ---------- ------- - 14- ' " 2 -- FINAL INSPECTION i3Y:._- cQ `! `' -------------------- Date -- - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California F.P.CC. R� --NY