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rUK UrrlLt USC: ------------- ----------------------------------------- ---------- ------- ----------------------------------------__________________ __ ----------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ------ -------- - - :. -•� 4 (Complete in Duplicate) --- --- Date Issued----- ---� •=='--�-�-- --------------- � This Permit Expires 1 Year From Date Issued 2-2Z — 3r0- l7 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 made in compliance with County Ordinance No. 549, I019Aj7-EC,(+ JOB ADDRESS AND LOCATIOty/_S_._.__ VE, A ------ ----- I CSF ��?1�W�_�__...D}�1_�. Owner's Name_______________ __ _Qa_ - # rr t 1 `-f--- --... Phone-- -------------------------------- Address---------:4.1-97-57----------D�---40------p A--------AVE _..__.-5�NT� CI—A."...�. li Contractor's Name--------FUA—L - --• - -1---------------< --- ----- Phone----------------------s Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p ,1 It i Number of living units: __I____ Number of bedrooms --- Number of baths Z_ Lot size ______/.S_ VO0 JZ -4— y-------------•----------- Water Supply: �Public system ❑ Community system ❑ Private Depth to Water Table /_-��__ ft. Character of soilto a depth of 3 feet: SandA�!rGravel ❑ Sandy Loam (] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date#__________________} No��New Construction: Yes [ to E] FHA/VA: Yes E] No 21 TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is availablewithin2004eet.). Septic Tank: Distance from nearest well---Jr. --------Distance from foundation_lD_-----------Material---- CRCT.0-- _ ff INo. of compartment, � ____.. --_____ - -- - _1� k_ •-Liquid depth__� -.-z- - .-----Capacity --- Disposal Distance from,nearAf- well ___,S-.Q_-_Distance from foundation._-.10---------Distance to nearest lot line__a_____ LTJ Number of lines__`__.* -----------_______Length of each line-_--6J?a'=33.__.Width of trench_____ _ r--- -_.-___-_.-- Type of filter material__)3.QC-----Depth of filter material------ -IT_ .....Total length-------- --------------------- ___W Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line__-_____.______._ (31 ❑ Number of pits_,�------------- ---Lining material.......... -Size: Diameter....!------------------Depth----------------------------_---• 1 Cesspool: Distance from"nearest well________________Distancerfrom foundation-_______.-----------Lining material------------------------------------- P ❑ Size: Diameter_..-„------- ---------------De Depth---'-------------- - - ----------- - -- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________________,/--------------------Distance from nearest building--------------------------------- ._----_. ❑ Distance to nearest lot line--------------------- ------------ r`3 -------------------------------------------- ------------ Remodelingand/or repairing describe :-------F41' --,EF,,___ $A E”' / p [ 1 X T3EpROoM D- E1-1_ C- -------------------- ---------------------------------------- -------------------------------------------` ---------------------------- -------- j t ' --. __ a--------------------------------------------- ------ - -- -------- It. I hereby certify that' ve prepared this application and that the work will be done in accordance with San Joaquin County (� ordinances, St to I d ru and eplations of tine San Joaquin Local Health District. (Signed --- --k-L%' --- ------------- - ifi--`® p'� 1 " `---�'�-i--�------ - - - --------- ------------------------- -------(Owner and/or Contractor) BY:-------- -•--------------------------------------- ---------- _ (Title) F- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ! k p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__Ti_R.-P-_ --------------------------------------------------------------------- DATE----- REVIEWEDBY-------------------------------- -------- -- ----- ------------------------%------------------------------------------------- DATE-------------------------- BUILDING PERMIT ISSUED-------------- --------------------------------------------------------------------------------------. DATE------------ Alterations and/or recommendations:--------•--------------- ------- ------------------------------------------------------------•_.:----------- ----------------------------------------` ------ :--------------------=-------------------------------- -------------------------------------------------------- ------------ t -------------------- --------------------------------- ----- - ----------- - ------------------------------------------ ---------------------------------------------------------- FINAL INSPECTION - - - ��------- -. - ------ Date------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.