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Permit No. APPLICATION FOR SANITATION PERMIT �?j� (Complete in Duplicate) 0 no p Date 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 compliance with County Ordinance No. 549. 1477--0 JOB ADDRESS AND LOCATION_�'_. ._J[0V.5e.-..•WC—<.7_ 11�---Lt_,�S°M.yj._4IY_b-----.--A Owner's Name-- F_..GA'_R -QAJ._.0-i .......4.yGr. ............C-:_W_,j/_I.ASI-------- l--C.I6i--)-------.--. Phone--- ------------------- Address .....4S""/_9.. --------A.YL°�---••--•---•-----•-•---•-------- ------•-----------------------------•---••-•------------------------•------- n - Contractor's Name............—D.-0---4-o--------1—A. _ La59------�-----S.ce./s.--•----Twe'4_------------- Phone_l -,!Pii r-47-------- Installation will serve: Residence �( Apartment House ❑ Commercial ❑ Traiier Court ❑ Motel ❑ Other ❑ Number of living units:(1/Sl_t° Number of bedrooms- Number of bathsW—e- Lot size ................... Water Supply: Public system ❑ Community system ❑ Private R( Depth to Water Tabie4i0__ ft. 7 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ( Hardpan [�]; Previous Application Made: Yes ❑ No 0 New Construction: Yes D< No ❑ U:- 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_.-,::;......Distance�Arom foundation_._/Q-".......Mater�al__0±�KC_R�_________ 1r. . XNo. of compartments._7"3�Y_f1-----------Site+ -." ___. �_Q�Liquid depth_.�.__------------Capacity_6Q_-_6f, Disposal Field: Distance from nearest well..�.........Distance from foundation...�Q_-_--___-Distance to nearest lot line...Number of lines...._L?1Y_�°_______-_.____---__Length of each line_____._.__________•_-.Width of trench-_� r-----•_•-__--_.__Type of filter material.�,�A"'.Rfl.�,...Depth of filter material.__/,21.-__.....Total length__.._4W..___.__._.___........Seepage Pit: Distance to nearest well____?/-. -___--_Distance from foundation.-_-70-._____.Distance to nearest lot line__lO_ .--__P4 Number of pits._49W_d____.__-Lining materiai_B.R1-4-&-.Size: Diameter._. ��-_.._..Depth....Zl_'__-----_Cesspool: Distance from nearest well_.--...._._.__._.Distance from foundation....................Lining material---.______--______-..-_-_--____-_:Size: Diameter... = De th - Li uid Ca aci a ❑ p •----•---- q P ty----------••--••... • 9 Privy: Distance from nearest well----_.............................................Distance from nearest building•__-___.-_-_-__•-_-------•---__-_____-__. ❑ Distance to nearest lot line-•-_..---•----------------------------•------•--•--•--•-•---•-------------•-•-------------------------•------•--------•-----------------------� Remodeling and/or repairing (describe):---- ------- ---- ---- ---- ---------------------------•-------------- 10 ----------------------------------------------------------------------------------------------------------.................-----•--•----•-------------------------------------------------............................ I hereby certify +hat I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a regulations of the San Joaquin Local Health District. (Signed)------ -a-------- I r ---ff�jon;fo _ .r,E-�Lr- i---------------(Owner d/or Contra or). B v --- (Title}. Y••-----••----•---•- --- -- --- ---- ----------- ----------- - ---------------------- (Plot plan, showing size of lot, location of system in rel wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---•-•--.-•---------------------•------•--------•-•---------•--•----------------- DATE-may REVIEWEDBY-------------- DATE----- ............................................ BUILDING PERMIT ISSUED ;:... DATE...........&f�..........------------------------------ Alterationsand/or recommendations----------- .................-........... =---- -----••-_-•----------- -----------------------•-------------------•---------------------•----•------•---- ----••----------------------------------------- ..........------------------------------------------------•--------•---•-----•-•---------------- ---•-•-••-••-------•-------•-••----------•------------•---------------- ---•---------••---••--•----------•----•---•--•----------•-------•-----• ..................:-_--------------•.---•------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ---•---•-•--------_---------------_ ----------•-------•--••---• ------------------------------------------------------------•----•----•-•----•-•---------------•-------------------------•--••-----------••---------------------•------------- /__. _:--------------- - '�-- --------------------------------------------- FINAL INSPECTION BY:.... ---- Date___ __ ______ SAN_JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Californle Lodi, California Manteca, California Tracy. California ES--9-2M 8-51 Revised W-2100