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FR OFFICE USE: iq-. � ��-- _---------3- - --- APPLICATION FOR SANITATION PERMIT Permit No. . (��— g._ -------------------------------------------------:- --- (Complete in Duplicate] 3D 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----------q--I-v--------------s...------- ----------------------------------------------- ----•---•-- ---------------- Owner's Name-------.---- 4Ylr ,i.�� C.-----•-------------••-------- --------------- ---- ------------- ------------------------- PhonekfO --] r Address----------- --- ` ......-----C-t-------ice. Li.n-.a - .o• Contractor's Name----------- ' ------fo�- ------ - "` - Q-,+ Phone-J4.0A 9i� Installation will serve: Residence [2( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _7--_ Number of baths ----I--- Lot size ----1AQ_ _________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table -(gip- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe tZ Hardpan ❑ Previous Application Made: Ilf yes,date............._-----) No New Construction: Yes ❑ No M FHA/VA: Yes ❑ No IM TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or.cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well----------------'Distance from foundation---------------------Material-------------------------------------.-----_---_. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- � 4 Disposall Field: Distance from nearest well))j94)E--.Distance from foundation-----1.D.1-------Distance to nearest lot line--- '___.. Number of lines____________1-----------_----------Length of each line-------------- -.-Width of trench---------------- _ _*..______ ad Type of filter materiaL_:ZX�C�K-------Depth of filter material----J -----_____.___Total length----------------3s. ---------------- Distance to nearest well- d __ r !v6Distance from foundation-_-. /P--"____.Distance to nearest lot line_____ _.. Seepage C �: N Number of pits-------- Lining matSize: Diameter_-.-_--3-3- --.---Depth-----------ii!___........... d Cesspool Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------------.-_-______._______-_. N ❑ Size: Diameter-------------------------- Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________#______----___-----________-__._Distance from nearest building------- ❑ Distance to nearest.lot line------------------------------------------------------------------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe)----------}�-�--A` --- '` ""+j- -------------------------------------------------- -----------------------------------------------------------------3------------------- -------------------------------------------------------------------------------------------------------------------- ---------------- C -------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------I--------- --------- ------------------------ --------------------- --------------------- - ------------------------------------------------------------------------------ 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. (Signed)----------D-- CA----•--•-199 ---------q-------t'�"�-------44, -------------------------------------Owner and/or Contractor) BY: �mr5, =. --------- -------------------'-----------------------(Title)--------- - ,- J c.-ter...------ ------- (Plot plan, showing size of to+ n of system in relation.to wells, buildings, efe., can be placed on reverse side). FOR DEPARTMENT USE ONLY /t) 719 -- U-- APPLICATION ACCEPTED BY------------ t ---------------- DATE---------------------- - REVIEWEDBY----------------------------------------- ---------- ------------------------------------------------------- DATE-------------------------------------------------- ------ BUILDINGPERMIT ISSUED-------------------` -------------------------'------------------------- DA•TE---------------------------------------------------_-------- . ;. .,. nd/or recommendations:--- ---------- ---------- -----•----•----------------------•--•------------------------- ------------- ---- ----terations 8�=�= �� - ti --------------------•-------•------•---------------------------------•- •-------------- ..._.. ------- -----•----------- ----------------------- ------------------------------ - ------------------- ---- --------------------------------------------------------- -----•---•------ ------------- - ------------------------------------- -- -- - ------------------------------------------------•------------------------------------------------ -------------------------------------------------------------------- -------- I _ FINAL INSPECTION Date -------- f � �F .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca,California Tracy,California E5 9 nEVIrW 8.59 3M 3-'63 F.P.CC.