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';.rU hFICE USE: - " _: -------------------------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _. Z77�__-_ -------- ---------- --------- ---------------R- --- •-- (Complete in Duplicate) L ,1 C� This Permit Expires i Year From Date Issued 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 madNCA%�F-----compliance with County Ordinance No. 549. 2p�pc� M JOB ADDRESS AND c1'TN___ , .- Owner's Name ...... 13`-----=-/--��_CK-�-a'----------------------------------- --------- -------------- Phortfe� W41 -- '_'7�- - A'ddress_. ---- - -.-_I --0x- __. 7 -----•------------------------•------•-----------•--•- Contractor's Name-----VN"F- 9 a - - ---- ---- ---- ---------------- ------------ Phone--------------- ..------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ MotTl,.❑ Other ❑ Number of living units:- )---_ Number of bedrooms __�-r-i'Vumber of baths ___ ___- Lot size ___ - - ' w +--------.- Water Supply: Public system ❑ Community syste Private ❑ Depth to�Water Table __ _ - If.t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand , Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: (If yes,date_-.__-.-- } No New Construction: Yes /No • FHA VA: Yes � LiJ" N ❑ / �_N° ❑ - —TYPE OF.INSTALLATION,AND SPECIFICATIONS: _ Cesspool Pe �,d'if �, ..- N'o se tic tank or cess ool ermitteublic sewer is available within-._200-. fee�t.) Septic Ta Distance from nearest well--- -----Distance fro fou�detion__!- _-----_MITe.ial__ - -QCC No. of compartments---------------------- ---Size---V -x_qX__. ---Liquid do.pth-- ;-i_ --------'--Capacity--,/ Q-- �m Disposal Field: Distance from nearest w�li-. ___Distance from foundation-_-1 t!E ......-Distbnce to,nearest to fine___ __________ " ---------------Length of each line----- -- '' Number of lines-------�----- - 9 - ��_.vti/idt of trench.--------- --�--------�-- Type of filter material______�0C:A_Depth of filter material----- _-.-__-_--Total: length_____________________ Seepage Pit: Distance to nearest wefl_------ -___-__..__ _-_Distance from foundation--------------------Distance to nearest•lot line----------- El Number of pits__ _ ________ _ ____Lning material -.-____-__ ---------..Size: Diameter.____ .---._ --------Depth- ! -=--=--------- Cesspool: Distance from nearest well-----------------Distance from foundationLining material_:._.___ ___❑ Size: Diameter------------- ------- --------- ------Depth--------------------- ------------- __ .______.___-. _ -----LiquicCaPacifi ----------- -----------------gals., D stance from nearest well _______-__--.__--_.._____-_..___._Distance from nearest Building___-__._-.,.______--_____-________---.._. ❑ 'Distance to nearest lot line----- - --------- --------- -------- --------------------------------------- - V.Remodeling and/or repairingP"fdescribe):----�0.f"Y1 M_ _- 4�'_N 1-'.T" -----------WEA �-----__-`-Z-5 /4 ------------------------------------------------------------------ --------------------------------------------------------------- -----------------------------------=----------------------- = - ------- -------------------------------------------------------------------------- ------------- I herebycertify that I have a wo �'� y 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. r Y . (Signed)- rf / � ' -- - -- -------- -- --- (OwrLnd/or Contractor) �-BY= ---------: - _ _ :: ?v+ ` ',. Ti -=- : = .- (Plo+ plan, showing size of lot, location of systein in relation to wells, buildings, etc., can be•placed on reverse side)., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-____- _ ` " -- ----��.------------------ ----------- ------ DATE-- REVIEWED BY-------------------------=----------- DATE--- -------•-- BUlIL DIN PERMIT ISSUED------=------------------------- ----------- DA•TE-------- - Aterations and/or recommendations:____ ._ - -------------------------------------------------------------- --------------•------------------------•--------------•------------------------------------------------------ ---------- w ---•------------------- ------------ - / -------- FINAL INSPEC - --------VA--- Date------------- '' (p SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.