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;* rUK U-rI-L USE: ------------------------------------------------------- -- ----------- -------------- -------------------- --- APPLICATION FOR SANITATION PERMIT Permit No. .l Sp •__ ------------------------- ---"------------------------- (Complete in Duplicate) - --- This Permit Expires 1 Year From Date Issued Date Issued —0-510 IS-- z6 s_ z,,F6_jp 6 Application is hereby made to the Sin This Local Health District for a perrrif to construct and install the work herein escrbed. This application is made in complian a with Count Ordinance No:"549. � � OwBer1pNams ----------- CATION---4 �.�- Q�. -->--��.r-.,�F:--f� -7 Owner's R=S- VH _- Nl---- --- - - - --- - - - ----- p - - - - - -- -- Phone-----------•------------ -----•--- Address-----=---------- _.. Q x Q.f p E-s�C t* LID N LA Contractor's Name -1/l/0 ,5...'a.eT_SI �.� - �'�E [_- 1[3 -"31 Installation will serve: Residence P" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑]7 OtheriEj- ��l�,t �# Number of living units: --I---- Number of bedrooms .�•,..�_. Number of baths Z Lot size ...�-....-- .. �t —A °k Q R. t �------------------- Water Supply: Public system ❑ Community system ❑ Private ET'Depth to Water Table #_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam Clay ❑ Adobe ❑• Hardpans r I Previous Application Made: Of yes,date.............___.-_1 No Fe New Construction: Yes ?a---No ElFHA/VA«. : Yes ❑ No.®— TYPE OF INSTALLATION AND SPECIFICATIONS (No.septic tankor cesspool°permt+ed if*pubirc=sewer rsavailab"le'witfiin'20p'feet:) "`�'"�� -" Septic Tank: Distance from nearest well .-6_ _.--_-Distan e from foundation.-.--X6. '- Material. 'Q/VC—R C j -------------- -- No. of compartmonts.-- i --.- ¢ /O.)(..- f Liquid t - q p Y � Disposal Field: Distarice'"from nearest .well Do nea rstance from foundation --------- _. �� Tl�lumber of�line+ s` `2- ""Length of ea'h'�1 e. .�- o ,Wsd�fi�oftfiren'ch"" � r '� - rest ! I.�s f , trType tof filter ma enalr"j s -----Depth fof jiRerlmateribl----- f y° Total length--' _: --'- ---------------------- Seepage ------Seepage Pit: Distance to nearest well_f5Q------Distance from foundation_._. stance to nearest lot line----S [ t� Number of pits- R�.� S ,.�.�f___,...-.___Lining material -�' _.---.Size: Dia;meter..� XS _-_.. 19...---Depth_...--- 2 Cesspool: Distance from nearest well.....:...........Distance from foundation- _`7.-__�L"ining material___----------------------------- --------------------- El ..---_---..-_ I ------------------ in ..;f l 'L,h`x I Size: Diameter. Depth ----------Liquid CapacifY---------------------------gals.0 I --------►1f/Kitt ,..y � Privy: Distance from nearest'well--------------------------------- -Distance from nearest buildin ru ❑ Distance to'nearest lot line-------------- ! ------------------------------------------------------ -----=---------------------------- Remodelin - ------- Remodeling and/or repairing (descril�e):.._-- ---_ --- -------------- = --------------- ----------------------------------- --- --------------------------------------------------------------- --------- ------------------------------ ------------------------ ------ ------- ------------------------------------------------------------------------------------------- . 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;regulSfi ns of A San Joaquin Local Health District. (Signed)-- --------.C_ r .: -.... ----- -- -- --�.�-�. - .� ---------- ------ - -- --------------------- -----(Owner and/or Contractor) - -------•- Title-- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be laced on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----7 R`- ------------ --------- ----------------------------- DATE-------- - - .. -------------------- REV IEWED BY------------------ --•--------------------- - -------------------- ---- DATE------------------------ ---------• -- - - -- ----------------- BIfiLDING PERMIT ISSUED --F-------------- ------------ DATE - ------------------------------------------------------- -- -Alterations ------------------- and/or recommendations:__.•-------------- ---------------------------------------------------------------------------- --------- -------- ---------------------------------------- ----------------•---------------------------------------------------- _.� �_....._ n .�•�.. ..�.. -------------------------------------- ---------- ------- -------------------------- ------------- - Cr ,y FINAL INSPECTI � Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltart Ave. 300 West Oak Street 124 Sycamore Street est 9th Street W Stockton,California Lodi, California Manteca,California 20T5 5 Wcy,California F.P.CO. I, k