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•FOR62fFICE fSE-- - -, , --------------------------------------------------------- _________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. 76 _•...__ ---- ---------- ------- ----- ------- ------- (Complete in Duplicate)) This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desrrT This application is made in compliance with County Ordinance No. 549 1? JOB ADDRESS AND ZOFATIc -D I A' 4P --�'-''�- --- ....-_I EE . 1 y-C3 R3 �,-e-A� Owner's Name--------- ---HTq - --------------------------•--Phone-.-.----....--------------•-•--•--•- Address................F-Q-•-------�pK..-•-_-6-9--1----------migaT CA----------------------- Contractor's Name----' 1 1A1 R'--------------------------------=---------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence t-_'Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1.--- Number of bedrooms - ----- Number o baths .ems Lot size _, ZO..---X__�. _r_L__ _________________ Water Supply: Public system E] Community system El Private epth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑, Clay Loam ❑ lay E] Adobe E] Hardpan ❑ Previous Application Made: (If yes,date--------------------J No Fr�__New Construction: Yes AON o ❑ FHA/VA: Yes No ❑ TYPE OF..INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic T-9,nk: Distance from nearest well---5_V_•_-__Disfance from foundation----1 ._N -..M t ial__CVVR T=.------ ______ ,'VX _Liuid -------- -----No. of compartments...___ 5 Disposal Field: Distance from nearest well...= �_.__Distance from foundation -- -----.Distance to nearest I t lin - -�~—,,r Number of lines-----------��---.-..------Length of each line------- W'dth of trench �� __.. J. --------------- - Type of filter materiaL___R_Q_�.�i_._Depth of filter,material____• '�, otal length-------T-�- _ Seepage Pit: Distance to nearest ell....1�2-_Q__._„�Distance from foundation_�r��_.l�istance to nearest lot line--._L Z3� Number of pits________ ___ _ ____Lining material �!� :-__ _ _ Size: Diameter_ _-_ _��__.__Depth-..--,/. -SOCK .' t Cesspool: Distance from nearest well_________________Distance_f{rom,foundation.............,..___.Lining material-_._)-...5 ---___. --- gals. 'T, ❑ Size: Diameter-- DePtw' y - ...Liquid Capacity - A-r7ALH r�i Privy: Distance from nearest well------ ------- -----------_------________________Distance from nearest building----------._-.-_---_.-___________..__._._ ]'"r ❑ Distance to nearest lot lir e------------------------ i Remodeling and/or repairing (describe):--------*rr ----c-=-----.-----_c---------- ------------------------ i ---- - -- -------------------------- ---------------------------------------------------------------------------------------------------------------------------:-------------------------------------------------------------------------------------------------- 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. s (Signed)----------------y:--- -----------------7--- ------------------------- ----- -(Owner and/or Contractor) ---- - ------ �_ .�.�rr (Plot plan, show g size ofot, locatio # system in relation to wells, buildings*etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY d APPLICATION ACCEPTED BY-----� -R,oi ------------------------------------------------------------------- DATE--------0_- 57776 ----+--------------------- REVIEWEDBY--------------------------------------------------- --- ----------------------- DATE_-------------------------- ----------------------------- BUILDING PERMIT ISSUED---------------------- -= - - ------------------------------------------------ DATE--------------------------------------------=- Alterations and/or recommendations:------- ---------------------- -------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------- ----------------------'�Lrt?!� `�`------- fir �---------------•-------------------- ----------------------------------------------- -------------------------- .. i 1• r % } -----•--------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -------------------------- - = ------- i e - -- FINAL INSPECTION BY:- Da -- ---- --------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 IF,Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. {