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FOP,OFFICE USE: �•r R t -------------- APPLICATION FOR SANITATION PERMIT Permit No. . _ll-p --------------------------------------------------------- {Complete in Duplicate) -/� �_ ----------------------------------------- ............ _-_ This Permit Expires 1 Year From Date Issued Date Issued 7 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 compliant with County Ordinance No. 549. Z �—((O� JOB ADDRESS AND LOC ATI - _T ' /V- Z41----OFF---- L»I --------------------------------- Owner's Name------444.1 Address Z� tQ ...Q .S ..!L... cQ �'x lC`t-l .---------------------------------- • •-•- Contractor's Name-------Var---/1 an-•-----ilke l e,P_ Ileen------------------------------------------------------------------- Phone. ------- Installation will serve: Residence I) Apartment House ❑ Commercial 0 Trailer Court 0 Motel ❑ Other ❑ Number of living units: ___f___ Number of bedrooms __3-_ Number of baths _,3___ Lot size ------OS!_t,141itofF----------- _____________ Water Supply: Public system ❑ Community system ❑ Private [K Depth to Water Table _, ^ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ . Adobe ❑ Hardpan ❑. Previous Application Made: (It yes,date--------------------) No ❑ New Construction:-Yes'P§"—No❑ ' FHVA: Yes ® No ❑�4 �� TYPE OF INSTALLATION AND SPECIFICATIONS: ll e,. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) m Septic Tank: Distance from nearest well------/-- _"___Distance from foundation---/Q_'---------Material-------Cf rG=_ ------<.- _--- 64 No. of compartments-------------GR---------Size---1&._,YS,_X---14.__.Liquid depth--_..��_________________.Capacity.____�,S�aa__ Disposal Id: Distance from nearest well...._�____j__Distance from foundation-----/_� p__.___ .__-.____-Distance to nearest lot line____Z.__ � [ Number of lines___._--. Jfr - -______Length of each lin ��_��'_�•�-��.Widfih of trench..___��--__--- __ f___ , Type of filter mate ria L__ Q_ -----Depth of filter material___.� ._+-------To#al length____________________,124x3. _-___.-_ Seepage Pit- Distance to nearest weft____}pfJ--------Distance rom foundation____-4.........Distance to nearest lot line_-!_ -------- Number of pits-------I---------- ._Lining material- G _.Size: Diameterg_XA------Depth-------1�__`---------_._ Cesspool: Distance from nearest well_________________Distance from foundation__-____-----------_ Lining material-----------------._-_______________ ❑ Size: Diameter------------- ------- ----------------Depth----------------------------------------------------Liquid Capacity-----'-----------------------gals. Privy: Distance from nearest well-------_---------___-------------------------_---Distance from nearest building--------------------------------------- . . ❑ Distance to nearest lot fine ---------------------- ---'-------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):_-- , - -- 1-----r -rte R a ------- �) pa� M!717------WA-S------X� -----------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- --- ------------------------- ---------------- ----------------------------•--------- - -------.-------------------------------------------------------------------------------------------------------------- - - 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 r (Signed)---------- ----� - - --- ----- ....-'--------------------------------------- _ =—....�_{Owner and/or-Contracto Y•--------•-- B _ ----- Title X4/1.---• --- • (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........ .`------------------------------------------------------------------ DATE------------=------- - ;Z-. . REVIEWED BY.------------------------------- -------------------------------- ------ DATE------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------' ' Alterations and/or recommendations---- -------------- ' ----- --- ------ ----- -----•-----------------------------------•------•---------------------•-------•------------------------------- ---------- - -------- ------------'-'-------- --------------------•-----------------------------------------------------------------------•-----------•----'-----------------------=------------ ------------------------- -----------------------------------------------------------------'---- ----- - ------ -- -------- - --------- ------------- ---------------------------------- ------------------ --------- -'-'-- ' ' ' ' -- ---- -' ..... . - - -------------------- '-- --"-'-'-'---------- ! FINAL INSPECTI Date. ------------- ------- T, t� ) SAN JOAQUIN LOCAL HEALTH DISTRICT , I 1601 E.l4asalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California