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FOROFFICE.US- E: ---------------- ------ -------- ------------ ------- APPLICATION FOR SANITATION PERMIT Permit 2-_ -------- 0_* (Complete in Duplicate) Date Issued A6 -This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instl the work herein described. This application is made in ympliance with County Ordinance No. 549. 2_0-1-too- 6 F-SCALON Soo .50 JOB ADDRESS AND L CATION. 42F-.- - SAO(, ------jE ------- 11T(E-_1 'Ph110 OR _ one��--------------------------------- ----------------- ----------- Owner's Name--------- ---- R.Alf4-C-14----- el Address-.......2.57_7A_0_........ ------- --------------- ;;,_OtVO_M_A------------- Contractor's Name-19AKPA�-----60 -�7130'M-----tf-Pe! >/#qK0---------- ---------------- Phone----------------------------------- Installation will serve: Residence E] Apartment House [] 'Commercial 0 Trailer Court 0 Motel El Other on/imytr4 Number of living units.- j--- Number of bedrooms 4---- Number of baths I... Lot size ------ CR eA--6�----------------------- Water Supply: Public system E] Community system [] Private [Depth to Water Table .Character of soil to a depth of.3 feet: Sand E] Gravel [I Sandy Loam El Clay Loam WR-"Clay [I . Adobe 0 Hardpan 3--, Previous Application Made: Ilf yes,date---------- ---- ----) No gTNew Construction: Yes 0 No-9j1FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -----40------Mate -al r70,N,_C-_R_e------ -------capacity----- Sept tic>k: Distance from nearest well---------- ------Distance from founda I on Mate No. of compartments_____..—_.__-- I!r ---- _�----Liquiddepth Field: Distance from nearest well_,,5CD.......Distance from foundation__- - ___.Distance to nearest lot line..... ------- fh Number of lines_-________ /-------- -----I-I-------Length of each line---- -----jFr-----VVidf1n of trench----- ------------ YP o� filter material--- X------Depth of filter material------/_7-----------Total length------------------------25----- --- 5 0 Seepage Pit: Distance to nearest well---/0.40-------Distance from foundation-----/0--------Distance to nearest )of line.. ------------- e JA— Number of pits---- f-----------Lining materiial_4R Z----------------- 0 C--'A�---Size: Diameter._. Y---Depth- - - Cesspool: Distance from nearest'well-------------- --Distance from founclation_---------------- Lin;ng material___---.-----_.._____.__.________-_.-. 4" ------- ---------------------- Size: Diameter--------------------- ------::--Depth----,----------------------------------------- Liquid Capacity gals. 0 Privy: Distance from nearest well-------------------------------- ----------- ----Distance from nearest building__._.___-------_______________._ -- 0 Distance to nearest lot line--------------------------------------------- ----------------------------------------------- - --------------------------------------------- Remodeling and/or repairing (describe):--------S/y _.P 1��C;------ vp-T;k ------------------- Tam..... ----------------------------- --------------- h------/!'1+` N---------------- --------- --- -- ------------------------------------ ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S!RY lai)VS, and rules and regulationsef flae,,Ean Joaquin Local Health District. --------------- ----------- (Signed)---- ---------- -----(Owner and/or Con+racfor) By:----------------------- G -------.- - - ---- - ------------------------------------------- -------------------------------------------- --------- --------- --(Piot showing size of lot, location-of i*fi-of sy- m in relation to wells, buildings; etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -•---_-------------- ----------------------------------------------- DATE------74 ------------------- REVIEWEDBY------------------------------------ ------------------------------------------ ------------------------------------- -------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ---------------- DATE----_------------------------------------------------------ Atferationsand/or recommendations:-------------- - ---------- ----------- - ------------------------------------- ---------------------------------- ------------------------------------------- - -----------------------------------------------------------------------------------------I-------- ------------------------------------------ -----------------------------------------------------------------I.- --------------------------------------------------------- ----------------- -----------------------6------------------------------------------------------------------------------- ------------ ------------------------- -CTIO Date--- ----------------------------------- FINAL INSPE SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California' Manteca,California Tracy,California F.P.120.