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rVl (}rrl( USt: --------------------------------------------------------- / q ._-. _____ __ _______________________----------------- APPLICATION FOR SANITATION PERMIT Permit No. ...l...L. .. .!/ ----------- ------------- .- --------- ------------------ (Complete in Duplicate) Ir ' '' ------------- This Permit Ex fres 1 Year From Date Issued Date Issued ___. L-I --G. S 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. W SIDF—. jr JOB ADDRESS AND L CATION_�'+Q - _9w_D _- - yam/ L//��rr plf �lr A-17 �! :_` . �tic!__Y-!_ �_._. _y _ ________________ Owner's Name-------------------- I -----------I 1!E Q. � ANK...M—C Pone Address -"-----O�-X--------- — f--------------4AT,�_FQ-F� Contractor's am ----- f�-� R Phone Installation will serve: Resides D�Apartment House EL Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms _ Number of baths __I--- Lot size __,AfCRffA_6.r.�___________________ -___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table r. _ 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...........:........) No jD----New_Construction: Yes ❑ No FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4� `. Septic Tank = Distance from nearest-well :-Distance..-from. foundation__-.._..Materi I,_.. Q -� ...... No. of co m artments.. � __.: Siie-_ p X�?�Liquid depth Capacity-----'�0 Disposal Fie d: Distance from nearest well---- Distance from foundation___-1- --------Distance to nearest lot linef_______________ Number of lines-----------t-_____________________Length of each line------7_5._-- Width of french-----�6----_-_--_--___.-__- Type of filter material--- Q_�e" __ Depth of filter material-__-f _____--_._Total length______ _________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------0 ❑ Number of kits----------------------Lining material-----------------------Size: Diameter----------------------Depth---------------------:----------- Cesspool: Distance from nearest well_________________Distance from founddtion------------------. Lining material--------------------.-_.___.-__-__-_ ❑ Size: Diameter-------------------- - --------------;Depth--------------------------------- ------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building_________._____-.-_-.____-__-..__-____._ ❑ Distance to nearest lot line---------------------------------- -------- - ----------------------------------------------- Remodeling and/or repairing (describe):_...fid------f7.EF>tg-L K--__FAt An1_.t`II_G---- sz _r___.Ti_R�Q-- ------ -A_t__�-•--Cc1r�}�. ---------------•------------------------- - . --------------------- ---------------------------•-------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ 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}____ = l�reu[� ...t= ------------ = -------------------------------- -(Owner and/or Contractor) F B Title (Plot plan, showing siz4 of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------Tr . -------------------------------------------- ------------------------- DATE---------- REVIEWEDBY------------------------------------ --------------------------------------------- --- ---------- --------------------------- DATE----- BUILDING PERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE---------- Alterations and/or recommendations:--------------------- - ----------------------------------------------------------------•------•------------------------------------------------------ ---- - --------------------------------------------- ---------------------------------------------------------------------------- -- ---------- --------------------------------------------- -------------- ---- ------------------- --•------- -------------------- - - --- ...--- -------------- - / FINAL INSPECTION _y ------- ----------- Date---- --------------------C/ ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street ti._ 1241 ycarnore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.