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FUKUFFK-t USE: ------------------------------------------`---- APPLICATION FOR SANITATION PERMIT Permit No. .[7f� ! --- --------------------------- ------------------ ------ (Complete in Duplicate) -------- -- This Permit Expires 1 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 descrbedl. This application is made in complia a with County Ordina ce No.'549. - _ /" t vlf s r ss Q�/�/� mss"c o►v' JOB ADDRESS AND LOCATI N}j ls - 7�TF1/-.1V1F6--V ��----------- -------`�---�- �---- — C Owner's Name -b r`- >---• ---- - Phone}� Address----------------F?T - � 1�=a Q ... 3 I Lf _/ ------ !: Contractor's Name------QW--N_F—. ---------------------- Installation will serve: Residence [9'Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: -1----- Number of bedrooms.__-_ Number of baths __-_l-__ Lot size ----J92CR & _ ---------------- Water Supply: Public system ❑ Community system ❑ Private Rj-"bepth to Wafter Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam°t�t✓lay ❑ Adobe ❑ Hardpan a-- f t • • t--s %. - a.I- - Previous Application Made: (If yes,date____________ ___.) No New Construction,: YesVo ❑ FFIA/VA: Yes ❑ No TYPE OF INSTALLATION AND. SPECIFICATIONS: r -��.�(No�sep+ic-tanks or'cesspool-permi++ed4f ptiblicsewer is'available-within 200Aeet1�� Septic Tank:t *1� ¢Dis`tance from nearest weli0_-- _Distance rom foundation_ l--------------Material--a2n► TELQCj« i T1,11� NO of compartments---- ? om artments___- NO from nearest well--- from found�at1ion_______-/0--ay— ------Dista,nce to nearest lot- line --e----_-_-_-_-_�- _ ..Disposal F Size -Xq� i�uid g� �44oC X n � umber of lines----_____f--------- ------------Length of each line_ _��,� 9Width of trench- ----a� Totallength_ --_______________ 0-_---------- � © Type of fitter material___ C. -----Depth of filterfmaterial'1�--g <----•-- F Seepage Pit: Distance to nearest well-- 50-- Dist from(foundation_-�__�� ____.DistaCe to nearest lot lineanc of _ g mfrClS-. Sze: Diameter. x ---------------- ---------- Cesspool: --- - + Depth �� Distance from nearest well----------- Distance from�founclation-------------______lining material--------------------------- ----------❑ Size: Diameter Depth-------_,--_. ------_----------------Li Liquid Capacity-.-.- m a acit -.-.- 9- P Y -------------gals. ! V] Privy: Distance from nearest well____ ----------------------------------------..-Distance fro m near est1building-----------------------------------------. ❑ Distance to nearest lot line___ ______---------______ !>4Vt0+AT i --------------- V T � �I-V Remodeling and/or repairing (describe):----- -��P.�.D------------------------------ -.------------------------------------•----- - -----------------------------•---------------• --•---------••--•--------------------------- --------------- ---------------------- --- --------------------------------------------------------- It i---------------------------------------------- ----------------------------------------------:------------------------- - ----------------------------------------------- -------------------------------- ------------------------ ------------------ ------- --------•--------------------------- ------- I hereby certify that I have prepared this application and that-Ake-workWrvill`6e-"done in ac o dance with San Joaquin County ' ordinances, State laws, and�ules and regulations of +he San Joaquin Local Health District, 5; (Signed)-----------40-. ________------------ --- ----------------(Owner and/or Contractor) ---------------------------------------------- --------------------------- . BY=---------- � --------'----------------------------------------•------------------------------------(Title) - - - -- (Plot plan, showing size of let, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR:DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY-------- ------------------------ ---------------------------------------- DATE------3----~- REVIEWEDBY---------------------------------- ------------ ------ -------------------------------------------------------------------•- DATE------- BUILDINGPERMIT ISSUED--------------••-------------------------------------------------------------------------------------- DA•TE------ Alterationsnd/or recommendations:----- ------------------------------------------------ ----------------•--- --------- ---- - `/ OF ....... -,_-lid err .= 11Piv� '� FINAL INSPECTION Date---------- - / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California F.P.C a. rr