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FUROFF,CE U5E:----------------------------------------------------- -- ----- ------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. _.IIX5 II } ----------------------------------- --- ---------------- (Complete in Duplicate) -,... Date Issued This Permit Exnlres 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.k County Ordinance ante No. 549.to r 2®�3iro—/3 { JOB ADDRESS ND L CATION 5, �1 - J'�.1/1rJ (3_ __I----- q ,, r 1� __��_847a � Owners Name------------(„J- 1_V---- L`L i. - ,(�# f .• _. r tl - Phone__ TT�SAddres . ---P//---------Al FF -T -- - : -------------- ---------- Contractor's'Name_-- _ �S_ /�------ � ..-_�t•. 1��_�_�__ �{7 --• ---.GQ/�S�',- �_ hones---{-�----•- Installation will serve: Residence eApartment House❑ Commercial-❑ Traile Court'❑ Motel '' f ❑ )Other ❑ Number of living units: f_-_ Number of bedrooms 3_._ Number of baths _�Lot siie __-_______.____- __ // -----------•------------ .Water Supply: Public system ❑ Community system ❑ Private �epth to Wafer Table __5- �? l ! Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sand Loam Clay Loam Cla s Y ❑ y ❑ y ❑ Adobt3❑ Hardpan ❑ Previous,Application Made: (If yes,date-_-_ J No New Construction: Yes ❑ No ❑ FHA/VA#: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . (IVo sei t p_c;tank or cesspoolpe_miIte_d if�p blit sewer is available within 200 feet. tt Septic Distance from nearest well----5� stance from foundatio�n�y r� r M ter al ---CIA �*P. No of compartments.-.-_ Dl e Siz X-- Liquid Capacity ----- �o Field: Distance from nearest well,---- `✓"�-__C-__.Distance from foundation---- Disposal ____________ -•-/-� +J Q Distance to!nearesf lot li e___-�F— .� Number of lines------7-- ---- '~L'e'ngth of'eeZfi`l � _ ----- I 1r T Type of filter mafieriaL- CV -__Depth of filter material___._-_ >r Width o franc Seepage Pit: Distance to nearest well_____-______---&6[)ista`nyeQfro foundation____�r.______j___ Diistance tohne"arl , t- t i est lot line-----------•_---- ❑ Dumber of pits -------------------Lining material-------- ="°^ Size: Diamefer---------g°""""�D.epfh m 1 rte" �?�� '.i'ify'� r �" -- -------- Cesspool Di Lance from nearest well____ -------Distance from foundation------------- 'L�inigg material- El Size. Diameter --------------------------------Depth-----------•-------------------------------I--Liquid_Ca'p_city*_ . --- . Privy: 1 i . ------ -----•-gals. stance from nearest well__________________________________ ___r_-_Distance from nearest b0clin ❑ Distance to nearest lot line-----------------------.-----__--___________---_-- I Remodeling and/or re airing (describe)------------___ -------_---------- 7 I ---------•----- -------------------- ----------------------------- --- -- ---------------------- I hereby certify that I Neve prepared this application and that the work will be(done in accordance with San Joaquin County 0 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District- (Signed)- --- 5 -- ---- ----- --------- ----- - ---- ------(Owner and/or Contractor) - (k5—p6 ___ ; = � - _ (Title) Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., cyan be placed on reverse side). - F kA FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 Y__r°' _._: . R-._C ------------------------------------------------ -------------- - ---- DATE----�Q._ __�. _ . ---- ---------- ------- REVIEWED BY-==-'--= DATE._ --- -- -------•------------------------------ BUILDING PERMIT-ISSUED:----------------- ______ DATE____ .. Alterations and/or recommendations:__E--------------_____-__ - ----------------------- ------------------------------------------------------------•----------- •-------•-------------------------------------- ------------- ------ - -- r= "� "� ti Y �`� - a ` f — a ---- ----------------------------------- - — ----------------- — ----- - --------- ---- - -----------------'--------------------------------------------------------------------------------------------- I FINAL INSPECT Date------ Q-. = -- ----------------------- -- SAN JOAQUIN,LOCAL HEALTH DISTRICT F 1.60 - ' .1 E.Ifaieltan Ave. I ,T 30D West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California _ ' r- .Lodi,California Manteca,California Tracy,California