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hVK Urrl(-.t u5!:,-,,, _ ---------- ---------------------- ------------ __-_-.- APPLICATION FOR SANITATION PERMIT Permit No. . ----------------------------- ------- (Complete-in Duplicate) .---._............ __-__ _-- This Permit Expires 1 Ybar From Date Issued bate 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 made in compliant t. County Ordinance No. 549. -�A _ JOB ADDRESS AND LOCATIO .firu1 i �\r _ 5 Rb�. l0-fit ---------------------- Owner's Name---------- -- -1-pa14----------LG_r�_--co---._...---- - - ----- ,, - Gl.t�l�--- -- -�c_.,SQ-�----- Phone------------------------------------ Address__. 11 - - f7!_� �!---------------47,53 -------------•------------------------- -------------------------- Contractor's Name Qul11 -------------•------- ---------------------- ----------- ---- -------------------••------ •---- Phone.. "� � J f 0"eiE ! !'WCQi s------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: __ ----- Number of bedrooms _ ____ Number of baths------.- Lot size -----ACAI_=06..�------------ Water Supply: Public system ❑ Community system ❑ Private R�- 6epth to Water Table .!;/ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------- } NoJF2 �New Construction: Yes ZI-110 ❑ 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 well---It?'q---Distance from foundation...Il-----------Material nts.-.___. _ CIV t'_ T` No._of tom artme �( `�- compartments, Z- ._--.5ize_ X Liquid depth = Capacity 9- N . Disposal Field: Distance from nearest well-. 1019----Distance from foundation_____W---------Distance to nearest lot line__- __ Number oflines__________ .. i ( t , -- --------------Length of each line-_ ___;25�-- -_-_.Width of trench--------2Y ►`------------- _ _ Type of filter material-_. ri _ iDepfih of filter mateal------f` ______ -Total length-------_-------'2_S -___-__--_ Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line__--__--_________ ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter--------A___-_--------Depth...A , Cesspool: i?isfance from nearest well ----------------Distance from _foundation..-. _..,, ..Lining material------------------------------------- 0 Size: Diameter- -- -------- ----- ----------------Deptli. -'--------;-- --------------------- ----------r -Liquid Capacity- ----------- -------------gals. Privy: Distance from nearest weft__--- - ------------------ ........Distance from nearest buifding------------------------------------------ IDDistance to nearest lot line _-. -------------------------------' - -------- Remodelingand/or re airin describe t I P g (describe):-- ,1�R141�--------�I_nr.�., -..�------j' Rc,�c.ATr°^�------P.nN�--------F0- --------------•--- ----- ------W. Ly-Y------- -------------- I hereby certify that I have 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. .. 5 � � 5 rl (Signed ------ ----- ----------------- - --------------- - --- ---- _ f -- .......... �1 ' er and/or Contract B I / Y-,Y'--� - -f _,--�....r �.. . _.....�-,__.___- , __-__�___-�-__,- -.-_- . ............._.._ -_- (Plot plan, showing size of lot, location of system in relation to wells; bu ldings, etc.�ian be 'p owing reverse side). FOR DEPARTMENT USE-ONLY _ APPLICATION ACCEPTED $Y1 R- ------ - ----- ------------------------------------- ------ DATE--.----- 3 ` ` �. REVIEWED BY-------------------------------------- - -- ---- ------------------------------------------- ---- --------` - -- DATE - BUILDING PERMIT ISSUED-------- -- ----------------------------- ---- --- -- -- ----------- - --------- -----------=--- - DATE.---------------------------------�------Alterations and/or and/or recommendations----------------- ...... ---------------- ---•--------------- --i-- ------------------------•----------------•---------------------- ------------- ----- 1f ---------------------- -- _- ti _.-...l.------- } ............ ---- ----------- ------------ __________ __ ____ _ .- _ __ _ _-_ _ _ _ FINAL INSPECTION _ Date............. ._� `. ?- -_--_--_- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press