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POMFOCE USE: -------------------------------------------------------------- r APPLICATION FOR SANITATION PERMIT Permit No. ._.. 3J.. f ----------------------- j------------------------ {Complete in Duplic-ate)e f-i h�1C3 .. 1- Da+e Issued _--_-- _---. -•-- --------------------------- .._ res 1 Year From Date Issued 1 Application is herebyma�e to the3a"n John neCo"ca�Hea � '� � _ i � pp � q Ith Distric�or a permit to construe+and install the work herein described' This 613plication is }node in compII c with County Ordinance No. 549. ' �--3 - O� ' CJ6 in is , S w- f*(7 JIJ I JOB ADDRESS AND LOCATION ` 71F �� •� SI CJ Owner's,Narnem== ------- '.._.. Q; --- ---------•---•_?---- ----------------- Phone-`- :d Address-=---' ? ---- �-...- a S ----•-•------r �p _T ------------------------------L.._...-------------------------------•-------------------------- F ContractorsName----- --- vvf1i�R ------------------••-•------- =--=------- -y.`- �""" ..-----•----------------------..---- Phone...-------------------------------- Installation will serve: Resident. Apartment House ❑ -%C'omertialk❑ Trailer Court ❑ Motel 0 Other ❑ It Number of living units: . ---_-_ Nu�bei of bedrooms __ Number of bathsY_ size � la{ Q.. Water Supply: Public system ❑ , Cornmue nity�system,.[a .�FriEete Dpth_ erabe toW�atl Character-:of`soil to a dep#h bf 3etand .Gravel ❑ Sandy Loam._[] Clay Loam`, ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date ] No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 2` --- TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic:tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well _.___ _ pistan e from foundation___...__'Ma en; t No, of compartments__-,_ ___'___.__Size——a�__�_�Liquid 2�epth ------------------_..Capacity.l��-�______: p1 _ Z 1 Disposal Field :,s Distance from nearest well--- Distance frorrm'foun ation____________________ ' tante to-Weare lot line__S~ p �� . . Number of lines-------_- -- --------Length of each linJ50-�" /- idthlof trench- -61_, -------------------- "�1�~" �� ^ r Type rof filter material_6 t_- '9 C-_K"Depth of;filter mat rial_____� ____._""_"T tat ength.___f_ O;_______________ _ t Seepage P& ;Distance to nearest we'll-------------=------Distance from foundlation___.._......_._____.Distance to nearest lot line------------------- } Cesspool: Distance from nearest well Lining material--nce from"foundaiton Diameter " Lining mate iap h 'Number of its-•--- ---------- Size: Diameter----------------------------------•--Depth-----_•--•----------))t----------------------------Liquid Capacity---1 ......--------------gals. Privy: Y' a Distance from nearest building € Priv � Distance from nearest well------ ----------------- ---- ------------- -- ----g•----_-•--.-------------------------- - - ---------- ----=----------�h _. ❑ ce to nearest lot line----- - k- - Fs - -- I Distan, a-k U I r Remodeling and/or repairing {describe)=------------------------------------ --•------------s� x►-ti ....... -•----•-----•----•-•---- --••-• i i i..,�1 y 4 f i ____________________________________________________ L.�.._._..--- _-__.___.._.__________.. ........ ----------------- --------------------------------------- s i 1 . 1 S . F .l hereby" certify that I have prepared this application•and fhat_ he work twill be done in accordance with San Joaquin County - ordinances,. State laws, and rules and regulations of the San Joaquin Local Health District. i J _-----Signed} _ :z✓2[z# � e - �r� _� � =� �a� �-- (Ovine d/or Contra ._ rI- : . .. g . . ---------------- ---------------- ---------------- Y:- - ' " s. {Title}..� µ (Plot plan, showing size of lot,10,cafion of system 1n relation to wells, bwldings'etc., can be placed on reverse side). e� FC :R pEPARTMENT USE ONLY*%r , rte_ / APP,LICATIC)N.f�CCPTED F3Y y' -- DATE----- ----- �f REVIEWED BY - --- DATE --------------------------------- BUILDING PERMIT`ISSUED-------------------------- � ''� - DATE,.: ' ' ----------------------------- Alterations and/or recorrlmendations:----------1�_'---------------------------•- ,'-'---------------------------------•-� -----------• " ---.4 K--- _"_•..-fir: .o' _ -----4'f4-CI4- -j_Z - -•--.START- ----- ---- t,� ------------------------------------------ �` f--------------- ----------------------------------- ------ ----- ---- ----- 5----- - r FINAL INSPECTIO ---- --I ----- Date = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak'Street 124 Sycamore Street 205 West 91h Street Stockton,California .,,Lodi,California Manteca,CcIIfornla 7rdcy,California. ^ 9 _ r E8.9 NEVIEC e•59-P.P.CO.2M&-so I e t r #�; B ;I _..