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r Vn VI 1 IyL VJL: •.. ---------------............. ...... .._.._._.. APPLICATION FOR SANITATION PERMIT Permit -------------- --_. .. [Complefil Duplicate) r� Date Issued _------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1s application is made in compliance with County Ordinance No. 549. 1 4 p �la } t E S JOB ADDRESS AND LRCATION-u----IO�-x- S._--- AjTRj 5!----------------„- F---------- ---EALOtV Owner's Nama. { Q — - ......� - -. Pho*...... ............... Address.__Z1?ik._i ......t.. _ _ --- 1_ fU - y a_--_------------------------- Contractor's - -- ------------- Contractor's Name----- E =----....: ._:FKM. ...-(X '3131_ -------------------- ----- ---------- Phone----- Installation will serve: Residence ( Apartmenf House E] Commercial E] Trailer Court ❑ Motel ❑ 14Other %� Number of Irving units: _. ..... Number of bedrooms I_. Number of baths_I-__ Lot sae ----- '�' ..Irs'fc `..__.._--_--.___ Water Supply: Public system ❑ Community system ❑ Private &'Depth to Water Table ar'ft Character of soil tow depth of 3 feet- Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam Clay❑ Adobe❑ Hardpan ❑ Previous Application Mede: (if yes,date---- 1 No New Construction: Yes f�' No ❑ FHA/VA: Yes ❑ No 2-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspdalpermitted if public sewer is available within'200 feet.) Septic Tonk: Distance from nearest well---TO-----Distance fromfoundation..-J9t_------Material..... .--------`-- No. of compartments_..-__._�----------_Size./_�.e?.. .........Liquid depth..._5.� .1"'_..._-Capacity..l'A___P.0__. \ Disposal • : Distance from nearest ell---5 ...Distance from foundation..- ....._...Distance to nearest lot lin�!............ v Number of lines--------_I---_-------------Length of each line..._-._��-../.v._-Width of trench---------2it. __f._.._... Type of filter material_BQ.CFN^......DeptKof filfbr material.....J/./t.._._._Total length-.................. D..f._-.�.....-..-._ Seepage It: Distance to nearest well....ill......_Distance from foundation...Ls+C.._.._._ Dista c to nearest lot l`ine�_?........ / Number of pits.._/.__-......_...LiningmcferiaL..BL2__�.__1..Size: Diameter.�.'. _V.. Cesspool: Distance from nearest well--------------Distance from foundation-----------------_.Lining material_,..__.._.__.____..._..._.__ Size: Diameter. .............. ......___.___Depth--- -- ---------•---- ----- ........Liquid Capacity-"................... .gels. drrtivy: Distance from nearest well..._..._._._._......--------_._..._...._.._Distance from nearest building.__.._.._._......._...._... .__.._. ❑ Distance to nearest lot line..... _. ...... --.-._.....___.-___----___'.-__-.-._____--__..._-_-_._.-.-___---- ------._....................... Remodeling and/or repairing (describe):...._..._. ' _ l�L --- `1927?1LfL----------------.__1z- -- ............... ---- -•--------------- ----- — - -.... .................................. --- ............-----------------........ ------------......................... -------........ - - - -------- ..............--•----------- .......... ......... - - ------- -_.....____..._-- --.........._--1....... --------- ._...._....- 1 hereby certify that I have prepared this application-end that theworkwill be done in accordance with San Joaquin County ordinances, State ews, and ruI a re�ylatioM of+ha San Joaquin Local Health District. (Signed)�_..� .1... ...... - ._ . ---- .. - ------------(Owner and/or Contractor) By:-----------.........................--- ----------- -. -----------------(Title)- .--- . (Plot plan, showing sil lot, location of system in felatipn to wells, buildings, etc., can be placed on reverse side). j� FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY--- -- 1+-`-�t ------ -- -— ------------------------ DATE....-1-L r� -c2• - ._......... REVIEWED BY........... ---- ...... -......_--------—------------------ -_ ---- - -.. DATE---.... - _ -- - - - -•-----•---.-------- BUILDINGPERMIT ISSUED.--- -....... ........... -------------------_--- ............------_---------- DATE_.................-- ................................... Alterations and/or recommendation ..... - - - - �---- ...._.................. ....................................---------- ---- -----. piT- p (-t . 6QoD 5i9 n/D _....... .-- •----..TiIHT. .!-�� ------ r►. pmr€ e[ 'u�' 1 ---------- D an�SrAe �E ..................... .. ...6 l! k ..:�-..t A B�c.�, a0pr_,.. .. ft o -._.. . f'- - - - . . . . ..._ . .. --- -- ------------------ - -- ---- -------------- t FINAL INSP _. l - ... - Dafe._ ----- -I�'P-�----------------- ---------_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Kamran Ave. 300 Wast Oak Sheol 124 Syawnon,street 29,5 West 911,Sheaf Stohton,California Lad1 California Manteca,California Tracy,California E 9 2M 1 67 Van9ovrd Rau