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A APPLICATION FOR SANITATION PERMIT Permit No. rte' (Complete in Duplicate) -q 3y/ J i Date Issued Application is hereby del 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. JOB ADDRESS AND LOCATION-----R-1515 v f - [ 'J/7I -----a Owner's Name �744�� •7Gfif'------------------ - ------------------------------------------ Phone__ ---��+p-[Of_ Address---------- ------------•-------------/--'!5- ---tom- U Contractor's Name �2-• �q 9'L S_9 �_VLC-&----------------------------- Phone -•--•- ---- ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑-� Number of living units: _4Y__ Number of bedrooms __ -_-_ Number of baths _r"I/ Lot size _- _ �______________ Water Supply: Public system RL Community system Private ❑ Depth to Water Table6-Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g- Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No 25�, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �} Septic Tank: Distance from nearest wakt- ohA-___Distance from foundation_tall___. _. No, of compartments--A Liquid depth Mater' rL#___�-__-_-C#a�#p+,a-�cit __ f y_ Qom_____ Disposal Field: Distance from near st weII.IjID_KP._Distance from foundation___I-0!--------- Distance to nearest lot line--____9 __.. Number of lines_________. --_.__ _ Length of each €ine____ '�_�_____________Width of trench----- -��_ p, Type of filter material Depth of filter material__-_._ _ tl�I Total len th____-_-�fl'_____________-_____ 9 41 Seeps a Pit: Distance to near e t well_._f vll�_--_Distance4rom foundation__Z_4_.......Dista�e fo nearest lot lin e-- Number of its__1_ _-_-------Linin material_____ Size: Diameter___ " p g - -- -. ��-- --- Depth--RX--' Distance from nearest well_____--___-___Distance from foundation-------------------.Lining material------------------------------------- El Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __-____________________________---------------Distance from nearest building-_-_---___.__-_-- _________________- ❑ Distance to nearest lot line-- C�4--------------------------------------------------------------------------------- Remodeling an /or repairing (describe):"'" __ ___ _ ____ -------- . '�-------------- s -•--- - - -----------------------f------------------------------------------------------------------ � ------------------------------------------------------------------ ------------------------------------------ -------- ------------------------------------------- ---------------------- ---- -------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and rules and regulationsofthe San Joaquin Local Health District. �-�+ _ .. -- _ . _ (Signed) ---- ---��-�-- � �-fig --- Y--�� -��---�-- ----`------ -- ----- - ------------------- Contractor) BY ,___(Title)---------------------- ------------------ ------- (Plot plan, showing size of lot, location of system in relation tos, buildings, et . can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- - - ----------- -------------- DATE -q-1-)l REVIEWED BY---------------------------------------- --- ----------- DATE--------I--- BUILDINGPERMIT ISSUED------------------------------------- ------- --- ---------------------------------------------• DATE.-------------------------------- Alterations and/or recommendations:_--------------- --------------------------------------------------••-------------------------•------------------------------•-•---------------------------- f f f L - •�` �/- --------- -- ------------------- ------------------------------------------------ ------------------------ ---------------- ---- ----------- ----------------3. ..... ------------- —" FINAL INSPECTION BY--------- -------cam --� - ------------------------ Date---------lfi45 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1.57 F.P.CO.