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FOR OFFICE USE: ---------- -- - ------------------------------------ - Permit No. --- --•--•- APPLICATION FOR SANITATION PERMIT --------------------------------------------------- / (Complete in Duplicate) Date Issued ---7/f --- -- ------ -_--------------------------------- --- This Permit Expires 1 Year From Date Issued Z,( 030 --Zko Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he r in This_ap.plication is-made-in compliance with County Ordinance No. 549: JOB ADDRESS AN LOCATION- - I/0'&/---- AV Owner's Name Phone- -. i Address--------- -----••"------- -- - - r Contractor's Name---------- /_F,,v- ' ''`y Phone.. Installation will serve: Residence RoO`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j_- Number of bedrooms _3-_ Number of baths Lot size _A4o'-%9449 .4F-'•------ ----------------- Water Supply: Public system ❑ Community system [-] private epth to Water Table ft. Character of sail to a depth of 3 feet: Sand (Gravel ❑ Sandy Loam F1 Clay Loam [I Clay E] Adobe C] Hardpan ❑ Previous Application Made: (If yes,date......_---_---------) No VK New Construction: Yes geNo ❑ FNA/VA: Yes W?' No ❑ C9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' � .0Se tic Tank: Distance from nearest well---10:P ___Distance from foundation_-Aa---------Maur�l-_�r� - "'l.ts- - --------------- Q p� No. of compartments_.. Size" " 74 4 A0 --Liquid depth_.��-------------Capacity- -,ZAQ------ h .11 Disposal Field: Distance from nearess well._ 4r_.._Distance from foundati n__�� _..----Distance to nearest 1�t line_ _.___..__ Number of lines -- -- -- - Length of each line__A00"_.- Width of trench_*..___--------------------- 9 Type of filter .material-- _ - Depth of filter material----/i --_-__..__Total length --------_-------------- -40 from foundation------------------- to nearest lot line----------------- Seepage Pit: Distance to nearest well----------------------Distance I ❑ Number of pits----------------------Lining material------------ ----------Size: Diameter------------------ -.-.Depth---- --------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material-----------.-------------------------. It ❑ Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------_-----.--------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line------------------------ ---- ---------- ------------------------------ --------------------------------------------------------------.--/�` - y Remodeling and/or repairing (describe):------- ---__ '' � ' -------------------------------------------------------------------------------------------------------------------------------------------------------- ------- 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. } .............. r Contractors (Signed)--._ ----bV00 ------------------- ------ -- a ---. ------------------ ------- - ----------- - - -- -- By:------- ----- ------ --- g {TitleP-- ------------ --------------- (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can.be,' laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -- ------------------------------------------------------ DATE----------------------------...----------------------------- REVIEWEDBY----------------------------- DATE`------------------------'--------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ----------------------- -- DATE----------- ------------------------ Alterations and/or recommendations:-------------------- ----------------- -------•-----'-----------------•----------- - ---------------- . ' ------------------ ------------------------------------------ _ ` -------------------------------.--___- -------------------------------' -----------------------------------------------...---.-..---------------------------,-------------------------------- -------------'------...-----_.._.-----.-----•--------------------------------------------------------------- ---------------- --------•--------------- x -------------- -- ------------------------------------------- ----.-._ -' Date--_- 1FINALWSPECTION BY:. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ' Stockton,California Lodi,California Mantecor California Tracy,California F.R CO.