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r-UK Url'K..t USL: -------------------------------------- L ----------------- i- ---------I------------------ ------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. --- ------------- ------------------------------ r (Complete in Dupilicafel -------------- -- --------------- ----------- -- -------- This Per Date Issued vr Permit Ex Year From Date Issued u., - . 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 i mpJia6ce with County Ordinance No. 549. JOB ADDRESS AN L TO - ------- ....... -----KRAMAI---------C*_1-_--------- Owner's Name... A, S, uAM-F—S------- R---------------------------- ------ Phone Address----------=--=:_Q_6 ----- --------Wrc&-L------------------------- 710.. - -----------------------------------------------------------------------� - Contractor's Name-- .. ------- Phone Installation will serve: Residence OApartment House C1 Commercial F] Trailer Court!E] Motel El Other [I _!!Z Number of livingum 0 of units: --- Number of bedrooms -Number baths Lot size•-_--_-Alf _ ---- --------------- Water Supply: Public,-"y tem E] CorMffiunify system [:] Private [] Depth to Water Table ft. Character of soil to a.depth of 3-feet: Sand E-_'Gravel El Sandy Loam E'] Clay Loam E] Clay El Adobe 0 Hardpan I-] Previous Application-Made: (If ye's,dote----------------- 1_:� TYPE 011� ..INSTALLATION AND SPECIFICATIONS:,. No New Construction: Yes 2r No Ej FHA/VA: Yes E�T- No E] [No'septic—tank-or-cesspool'�- permitted if public f 7,s-available witk:n20Q feet.? e from foundation_ Septic Tank: Distance from nearest well___-5�Q----Distant ---10--------- Mat No. of compartments-----47 ----------Size_yC50-0--- depth--.-- Capacity--- no DisposaJ Field: Distance from nearest i�_50...Distance from foundation-__-/0------- :Distance to-nearest lot line--16— Number of lines-:__ _'. ' trench---------6_--- 3 --------- --A----------Length of each line--- �idth-of trench-------- -6.1f ------------- Type of filter material--- . --Depth of filter material- ------Total length-------------------1/1 ---------- 5 " Seepage Pit: Distance to nearest well - -------------- foundation- :•-------.--..Distance0,KL , �5'1 -----Distance from - to nearest lot line--------------7 0 Number of pits-1--- ---------_---Lining material---------- - - --------Size: I i e: Diameter.----------------- ---- Depth---------------------------------- Cesspool- Distance from nearest well-----------------Distance from foundation___.__-..___---.-_ Lining material---.- -_. -C El Size: Diameter---- ---------------- -------- ----- �Di�pfh------------------------------------ Capacity-.------------------------.:gals. --------------------- ----------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well --------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line Remodeling and/or repairing (describe:-.__-- ---__ _ -------------------------------------I----------------;-------- ------------------------------------------------------------------------------------ 4 t-------------------------------:-------:-------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------- ---------------------------------------- ------------------------------------------------------------------------------- ------------------------ -------------Z------------------------I ----------- --------------=--------------------------------------------------------- ------------------------------------- ----------- - --- -- - - ------ - --- ------ -- - - -- - I hereby certify that I have prepared this application and that the work will be done in actord-a-'h-ce.-w-if-R--San--J.oa-quin- 'C'o-u-nty. ordinances, State laws, and rules and, regulations of the San Joaquin Local Health District. (Signed) ----------------- ---------------------- ------------------------------ ------------ -------------------------------------- -------(Owner and/or Contractor) By:.-- aL (Plot plan, showing size of lot, location of sys in relation"to wells, buildings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ f_3_20----------- ---------- ------------ DATE------ - �/ `. �5 _ - ------------------------ - REVIEWED BY ---------------- DATE ------------------------------------- BUILDING PERMIT ISSUED------- ------------------------ ------------------ ---------------------------------- DATE------ --------------------- _Alterationssl and/or rec'ommendations:--------------------- ----7-44-K------- - ------------------------------------- -------- ------- --- ---------- --------------------------------------------------------------------- - ---------------- - --------------------- ----------------------------------- ------------------------------------------------------------ -------------------------------------------------- .11��__,_-1/------- ------- ----------- ---------- ---------------- 6 ------------------------------------------- ----------------------------- ---------------------------- - -- ----------- - ---------------- ----------------- ------------------------------ ------------- -------------------------------- FINAL INSPE-C-TIO.N— ------ Date_...... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon Av*. 300 West Oak Street Stockton,California Lodi, California 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California F.P.CO.