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FUROFFICE USE: _ -- ---------- ------------•----------------------------------.------- APPLICATION FOR SANITATION PERMIT Permit No. ../17.3- .2_ �t ------------ - _7- -- -----�-.- - (Complete in Duplicate) i Application is hereby made to the San Joaquin-- --- This Perm auln Lo It�res ] Year From.Date IssuedcDate Issued --O2� Local Health District for a permit to construct and install the work herein descr�6ed. This application is made in compliance with County Ordinance No. 549, i5a S�n 1 i JOS ADDRESS AND LOCATION Std 1T-R ----- ------\!_.F.----- _��..��-- - � e� �t-�s�1-N �,D 4 Owner's Name----------y------�[FRF--D--------- 19_R_i3_,E- -------------------------------- --- ---------------------- .............. Phone------------------------------ Address -_ y©----- _T ------------------------------- Contractor's Name----------•---- ©kVN_f ---------------------------------- ------------- Phone•----------•------------•- F Installation will serve: ResidenceF Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: I------ Number of bedrooms_- Number of baths Lot size Water Supply: Publics stem / pp y• y ❑ Community system ❑ Private Depth to Water Table,l-�_�__"ft. , Character of soil to a depth of 3 feet: Sand4?__1`Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe E] Hardpan p l Previous Application Made: (If yes,date-_- ---- , ) No ew Construction: Yes ❑ No &FHA/VA: Yes ❑ No.� TYPE OF INSTALLATION AND SPECIFICATIONS: ' T (No septic tank or cesspool pert`Tiitte l if public sewerlii available within 200 Septiclank: Distance from nearest weil__y?_ -.-_Distance from foundation___) Materi I__R_Ct> fn0 tr No. of compartm �x_ ents____-_ _..__.-_-__Size- )Q -Liquid depth---- Capacity-12-0-0 Disposal Field: Distance from nearest well----5.0_-.-Distance from foundation----10---------Distance to nearest lot line- Number ine----------------- Type Number of lines--_.--------- 3_-__ --------------- of each Iine5V.:,�Q_+3_Q.Width of trench_._.36-_-_.__ _ Type of filter material'-(1_C_I'5,____Depth of filter material-__-_ ...... ...Total length---------/,/_o---------------------- Seepage ----r__--------- -Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line--------- _ ❑ Number of pits----------------------Lining material----------.-----------Size; Diameter----------------------- Dept h-.-------.-----_---------__-.----.-.-_ - Cesspool: Distance from nearest well-----------------Distance from foundation.................. Lining material------------------- ------------------ E-1 _----____._ -_.❑ Size: Diameter - Depth -------•---------- -----'--------- Liquid Capacity gals. { ` Privy: Distance from nearest wO--------------- ---------------------..-._- ___._Distance from nearest building---.----_-_---_-_-_-__--_------------,- ❑ Distance to nearest lot line--- - ------ Remodeling ----Remodeling and/or repairing (describe): ---/.0 �f I- � � TK_------ AC p � ----------rl-nC Fl ......---1^��.P�S� � 5-111 _oq- _ A--i—L—------ r— it _sZl� �• ----- --- i I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joa uin County ! �, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � —{ e (Signed) '� ----------------- ----------- -------------------------------- { I �,,,,...�-- - ------ - -----�- carter �.r=.....� _----- -- - I { and/or Contractor) 1 gy - - � _(Tit e)--�---� ." _��-�•-�;::- .. (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 r a APPLICATION ACCEPTED BY---- ------- ------- ---- ------- ----------------------------------------- -------------- ----- -- ------------ �� ' DATE_ ` ------ : r t REVIEWED $Y -- ----------------------------------------------------------------------------------- DATE------ `-------------------------------------•------------ '�'" .. BUILDING PERMIT ISSUED------------------ - '----- ---- : DATE--------------------- -------------------------------------------and/or recommendations:_ --.. Il?--/-.�=5-------NRr��I-cor� f�1 cD- . Nq0- �-N 1 7--A-W! = ------------------------------------- � �-r_N-r�------N _ _b�-0 - Q-�K.: AW-1 +r b�. --------AII-t-X ECJ)--------cW f.-FI-1----------l ocK---- ` --------------------------- ----------------------------------- ------ ---------------- -------------- - ----------------- 7 �f- FINAL INSPECTION BY: Q _.__. ._ _ (� Date-----;.---.----, .-- f _. 5--.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Montecar California Tracy, California ' F.P,6 0. '� 1 � t