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FOR OFFICE USE: 4C ------------- ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- .--,---------,--r-,—.------ (Complete in Duplicate) 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. 10 AITCA to --------Ki-m-5-EAL --------PR--------------------------- JOB ADDRESS AND TION -5/_ --Phone---- ------------------------------ Owner's Name------------------UEP -------- ----- - Address------------ATE.=-].........BOX-------lyo.....6-----I-----------M-T ---------------------------------------------------------------------------........... Contractor's Name d f ------sr-aw_cs�_----------------------------------------------------------------- Phone..--------------------------------- Installation will serve. Residence OgooApartment House [j Commercial E] Court ❑ Motel Ej Other 0 Number of living units: Number of bedrooms 3-- Number of bath:raiIe 43( []Lot size ----- -- ------------------- Wafer Supply: Public system El Community system [I Private [/Depth to Water Table -7 ft. Character of soil to a depth of 3 feet: Sand E--,,Gravel [] Sandy Loam L-1 Clay Loam [I Clay [] Adobe E] Hardpan Ej Previous Application Made: (If yes,date----------- -------) No g5,--New Construction: Yes gT""No E] FHA/VA.. Yes E] No kfoe_ ,.T.YP_E_0F.INSTALLATION .AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from- foundation_ ___/0-------k4al I CIL)/q.CR_E7FX____ Z14� Septic Tank: Distance fro'm' nearest well__:.---Distance - 4 �I pro,, No. of compartments-----*� e ---- 7, _57 Liquid depth-__21�1 -------CaFcit�-J_Zo --- --------Siz Disposal Field: Distance from nearest well.-S-0.....Distance from foundation------/10-*------Distance to nearest lot line--- Number of lines-----------7—----------- ---Length of each of tren'ch-L1�-- --- 6--:--------I---------- Type of filter'maferial---R-OCK,-Depth of filter material--- -----Total lengfhA -------------------- Seepage Pit: Distance to nearest well-------------------1-Disfance from foundation---------------.-_Distance to nearest lot line_________________ ❑ ine----------------- El Number of pits----------------------Lining material.--------_-----------Size: Diameter--------- --------------Depth--------------------------------• y epfh-------------- --------------- L I I F Cesspool: Distance from nearest weil------------- ---Distance from foundatiion----- --------------Lining material--.-..._---___..--____-__..______-_- I F-I Size: Diameter------------- ------------------------Depth___:------------------------ ----------------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_;---------------------------------- ❑ ------------i.-j --------------- Distance to nearest lot Iine---------------------------------------------------------------------------------- - ------------------------- .... Remodeling and/or repairing (describe)------= ------------------:--------------------------------------------------------------------------------------------- ----------------------T/614 ---- -------W-TH-------- L- ----- --------------------------------- --------- --------�3 T-A K r-11------0RA_1_aA&g-__ --------RP>11A1 U—C------- CHA_J\j60__. -----------------------------------------------:---------------------------------------- ------------- - -- - ----------------------------------- - --------------------------------------------- I hereby certify that I have Orpared this application and 'that the wo&%pill be done in accordance with San Joaquin County ordinances, State lamps and rul6s and r'equiations of the San Joaquin Local Health District. (Signed)-- 11 ------------------------------------------------------------------------------------ ----------(Owner and/or Contractor) law -----------------------------------------------------------------------------------------(TefIe)rz__-_—______.-_--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--. -----F� ---------------- --_---------------------------------------- DATE------- -------------------- REVIEWEDBY----------- - ------------------- ----- ----------------------------->- - ------------------------------------- DATE-------- ---------------------------------------------- DATE------------------ ----------- ------------------------- BUILDING PERMIT ISSUED------------------------------------ --------------------------------------------------------------- Alterations and/or recommendations:-- - ------------------------------------------------------------------------- ------------- ------------------------------------------------------------- _ell - --------------------------------------------------- ------ ----------------- --------- -- ------------ - ------------------------------------------;------------------------------------------------------------------- -- -------------------------- --------------------------------- ..............I------------------------------------------------------------------------------------ ----- - ----------------------------------------------------------------------- - --- ------------------ ------- - ------------------- -------------------------------I------------------------------- ------------ --I---------- ---------------------- --------- - --- ----- ---------- ---- ------ ------------- ------ -------------- ------- ------------------------- ----------------------------------- -- ---- -------------------------------------- FINAL INSPECb B ------ Date ...---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California TraCYr California F.P.r O.