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FOR QFFICE VSE: --------------------".____.__------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- -------- ----------------------------- (Complete in Duplicate) Date Issued ta._-J� � ------------------------- ...... This Permit Expires 1 Year From Date Issued2o`f-flr0- ag . ,;Appl;cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a lication is made in complia ce with County Ordinance No. 549. 4:4 H Ra t� JOB'ADDRESS AND LOCATIO ---------- - T�-:I FCA R ----- I Owner's Name -------/01V ----- Phone ---- -Address--------•------- - 1 1 Contractor's Name---0_W_N F:K ' --- I----------........... ----------------------- ---------------------------- --- ------------ Phone----------- •--•---------------- y I � House.❑ Commercial [-] Trailer E"'Motel L) Other E]Instaliataan wall serve: Residence E] Apartment' Number of living units: _--l-__ um ber of bedrooms 12-7- Number of baths ---/-- Lot size __._ Y�"__�__..f -------•"""""_"-_"._ 1 N r Water Supply: Public system❑ Community system E] Private Depth to Water Table """V ft. -j I Character of soil to a depth of 3 feet. Sand .Gravel}❑ Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E] Hardpan C-]Previous Application Made: (If yes,date--._...F_ ,_,:-__..} No New Construction: Yes [ No ❑ FHA/VA: Yes E] No RT-1 f TYPE OF INSTALLATION AND SPECIFICATIONS: '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- _©-----Distance from foundation � N_8 of com artmenfs_____ __________�^ p � '"'�'_-"Size �_��_�--Wit.-----Liquid depth-__._. _ _--"CapacitY------- ------------_ a Disposal Field: Distance from nearest we€L__5.0.....Distance from foundation____--/0__----Distance to nearest lot line__"_�J_---- .� 1 Number of lines------------_ -----------._Length of each line-.-APP f__-_ r Width of trench____--"'f f-_.-36-__- (� Type of filter maternal----p/�Q-�. .__ ___De th of filter material_--- l/ Total length- ------------------- Seepage Pit: Distance to nearest we __ ____________ _Distance rom foundation ��r______.Distance to nearest lot line------.___.__..._ ; ❑ Number of pits-------------------"""Lining material-----------------------Size: Diameter.----------------------Depth--._....____-----------.-------- Cesspool: ,y Distance from nearest well----------------"Distance from'foundation....-------------_Lining material--------.---------__._"""________.._. ❑ Size: D�meter--'..........-------------------------Depth------------ ---------------------i---------------Liquid Capacity--------------------------gals. Privy: Distance.frc m nearest well-------------------------------- ----- g--------------------------------------- _.--.Distance from nearest building A..c ❑ ------------------------- :.Distance to"`nearest lot line..-. -------- -------------------------------------------------------------- Remodeling and/or repairing "(describe}:---------------------- t -----------------------•------ t = f----- I e r or fiances, State- and rules and regul tions of the San Joaquin Local Health District. - - --------------- ----- - --- ----- --- --- -- -- -------------------------------------------------------Y - I hereby certify,that I have prepared this application and that the work will be done;an accordance Wifh San Joaquin County T. {Signed)---- - - --............... -- •---------- - - G *-(O and/?r',Contractor) •. ttif By:---------- -------------------------------------,-----------------------------------------------------------( 'i e) - - `- -------- ----- -- `tPI'6f plan, showing sire of lat, location of system in relation to wells, buildings, etc., can to placed on reverse side). FOR DEPARTMENT USE ONLY = - DATE --------------- t . APPLICATION ACCEPTED BY____--- ...�]i._.__ ..• -- REVIEWEDBY =----------------------------------- •------ ----------------------------- DATE ------------------ BUILDINGPERMIT ISSUED-'-------------------------------- ------ --------- --- ----------------------------------------------- DATE------------=-------- ----- --- - Alterations and/or recommendations------------------------ ---=--- --------�c��. ._-. ! � ------- _.._1 �- --- ---- `2Z-- �� K- ---- ®q-�a------- ------ -- --- --- ------ --------------------------- �,"` + _.... - - -�------ �- - ----- ------ ------ l - -..___j _....__._- - ------------ t1 €/bEt.E ice? ` --------- it �G..�.k rwr�'__ -�" �- � -- FINAL INSPECTION BY: `- ----�--r e ... ----------------- .......... ------. . . ------ ,,?'�;. ,,yy �4.ra @. �/� Com•f�.'.� �/ .�� +��/+�fi�� , �� SAN JOAQ 41 LOCA'C HEALTH DISTRICT 1601 E.Ha:elton Ave. s 300 West Oak Street i. . * 124 Sycamore Street 205 West 4th Street I Stockton,Californic-n. Lodi, California Mantecar California Tracyr California l/-11-66 - C-Ri%000 eAMF !nf SA 1"t> I- _PCH �c n��.� I