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I FOR OFFICE USE; A-1 -A_ t - ----------- --- ------ -- - - ---------------------- - ----------------------------- ----- - APPLICATION FOR SANITATION PERMIT Permit No. ......._�.�'�: � ---------------------------- ..------. [Complete in Duplicate) + ,, Date Issued '-:R_7k _..........._...................... ,.___.-.___._..._ This,rermit Ex fres 1 Year From Date Issued j Application is hereljy made to the San Sbaquin Local Health District for a permit to construct and%insfall the work herein described. This application is made in compliance with County Ordinance_No. 549. 2-77 - 1&0-07 ADDRESS AID CLOCATvj �`_tij ----�_AI ES ?. `%la .i''!-�./Owner's Name_____1A---�l' --- Q-1 �----------FAR S---- ------ --------------------- ----------- Phone Address-----•--------=--=-a.__ ---------------------------------------------------I Contractor's Name_ a) _ES..__r� Q �-L---- - v-I - ------- -------------�2 2_$_S_1.-b- __... P€lonei?6✓r� - i•7- i Installation will serve: ..Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel j[3 Y_Other Pe"ECCT Number of living units: _ Number of bedrooms _.' Number of baths__:t-.._ Lot size �.�EA _�...___.;___ �------- C, --------R 0 Water Supply: Public system 1jCommunity system❑ Prrvate depth to Water Tabled- _ ft Character of sail to a depth of 3 feet Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑! Cla'y ❑ adobe ❑ Hardpan ❑ Previous Application Made: (If yes date__-______.-__-.__- J No New Construction: Yesw to [] FHA/VA: Yes E] No R---' TYPE OF INSTALLATION AND SPECIFICATIONS: [No sepi'ic+aRk or cesspool-pe mittecl if pudic se"wee is avai[aEile Septic Tank: dot of compartmentsrr well.- ______Distance from m foundation- ./ ----------Material COVCI=1`.�: j r fOl_�_- ---------Liquid depth---J i - ---Capacil ------_ _ } / s©o Disposal Field: Distance from nearest well,--5, ___...._Dis once rom oundation__.,1� Dian'ceo aiest lot line___ Cy Number of lines-------'2r------------------Leng}h of each line__ ._11119....-.. ----.--Width of.trencflr___---36_`:r�_--..._�_._ (" Type of filter matenal__FQ.��.____Depth of filter mater�aL._._L7 � ----------.Total length------"�-------�------------ y----. O ! Seepage rt: Distance to'nearest well------/.p_0------Distance from foundatio,n----10--------Distance to nearest lot line-----�.=___- tDe- pth •_, Number of pits —.._.___Lining mate�ia1.R�.4 __ SizE:, Diane}er.� =Z12- 1 4 . Cesspool: Distance from nearest well ___- -----------Distancecefrorri loundafiofi.. .......... ..Lining maferial__._..----------....---------- El __.__ _❑ Size: Diameter. ------ ----- - ----. Depen ;_---== =7- -------I- ------------- Liquid 1Capacify--------------- -----------gals. t Privy: Distance from nearest well--. .........._ --------------- g __._._Distance from nearest buildin ._.___._,..._________________.-�_.._. ❑ Distance to nearest lot line------t---------•--------- ------------- 1 > ----- ---------!--------- 4-' Remodelin9 and/or repairing (describe :_-.�;FLv WAT _k-------- - ---- .5 �-------- u� ------ ---- ---- HI-6A-- _---.5oops-----CN7t, `_ x , ----- ---': ----- -------------------- - - ------------------------------- t---------- =----- - -------- ------ I hereby certify that I have prepared this application and that the work will b® done in accordance with"San Joaquin County ordinances, State laws,and rules and regulations of the San Joaquin Local Health District. ! t (Signed) ------------------�-'-�------ --- -------_----- � -(ow�ner and/or Contractor Y. Y buildings, #c.� can{bele laced on�revet• -.--- R - -------- - ----- - ------ (Plot plan, showing s4e of lot, location of system in relation to wells, p t se side). "- ' FOR DEPARTMENT.USE ONLY !�!, APPLICATION-ACCEPTED BY.- '--------- - - ----- - -- f� --------------------- -- DATE/-- ,.6. -------------------- REVIEWED ----- REVII WED 8Y - ----------- ------ - - ----- - t ----- ------ ----- DATE--------------- = BUILDING PERMIT ISSU.ED-------- ---------------- ---------------------- '------ - -`DATE------ --------------'' f'' Alterations and/or recommendations:.-----•. -•------ .....:............:.. � � ------ ... 71- ------------------------ - --- •-- -- ----------- ----- - - -------------- ------------------------------- ---------------------- FINAL INSP ! -. � �-Z6 Date I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press ' e