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1;-L UOE: ----------------------------------- ------------- ------------------------------------ ------------------ APPLICATION FOR SANITATION PERMIT Permit No. _C�K d --------- ---------- ------------------ (Complete in Duplicate) —------------------- ----------- --------- --------- This Permit Ex fres I Year From Date Issued Date Issued _6__4� Application js',her�eby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliahce with County Ordinance No. 549. P4TCP ----- -- -- ----- - JOB ADDRESS AND LqQAT'CiNri�5__ 4-0 5- PA V f_F�� 1-7-1-0-L4--------- Vj-, - -------------- ------ Owner's Name----t t — —.-I y K I I -- "-.M---------------------------- ------ Phone-9'23------0-W Address------------- - 5 4TAI i D ' 1 ---------------------------------- -------- Pf ------------ ---E,: Contractor's Name------FVA:!r��EL_P............................................. ---------------------:------------------------------t--------------------------------------------- --------------------------- ------------------ -------- ----------------- Phone Installation will se-rye- ResidenceApartment House 0r.fom`merci6I El Trailer Court ❑ Motel D Other E] Number of. living units- j--_-- Number of bedroom'sNumber of baths Al Lot size --- Ow a 1, I ------------------------------------------------ Wafer Supply: Public system Ej Community.system [I Private bepth to Water Table _81.. Character of soil to a depth of 3 feet: Sand R;�Gravel 171 Sandy Loaj [] Cf M ay Loam E] t t Clay El Adobe El Hardpan Ej Previous Application Made: [If yes,date ------------------ Noj!jj��' ff New Construct ion': Y --Iq� El 0 PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: es pu a septic'+a—n-k-*'r cesspool�prrnfffe_d i N ic sewer i s av ilable.wifhin 260-7eet.) Septic Tank: Distance from nearest well_..-SP----Distance from fou'hd6fion V0. . . fe I ------ Disposal Field: ----------Ca pacity.- No. of compartments------2—------._--Size-AITI-Q 5____1 - ------- -- CRFF. n�... Distance from nearest well---- Li�qicl clep�th__._ Number of lines-, '2—. Distance from foukndafioh:!_ _�_�_O---------DisfanCb to nearest.lot?line---- Length of each line--/00 t a------------------------- --- ------- ----- Width of trenchi--------1.,2'q' Type of filter m 'teria)- _AQ-!;ZK---Depth of filter material-_ Y7--------_Tofal le�ngfh-----------------Z 9. -0----------- Seepage Pit: 'Distance to nearest WO ----- --- ----------------------Distance from foundation-—--------------Distance to nearest lot line ❑ Number of pits---I-0-------- ------Lining material___" ------------size: . ^1 , - t-, DiAefer-----------------1----Depth-------e---------------------- Cesspool: Distance -from-near 'wellI 'St well-'� V � .1 e ------------- ---Disfanc� from foundation - 'aterial El ----------.. Lining material ------------------------- _�ize �;amf.rer.---I------ -------------------------Depth------------ - ---------- ---------------------. Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well-------------------- --Dist nce,from nearest buil,ding---------------I------------------------ Distance to nearest lot Iine--------- ov' .0or- ----------- Ia. %. -- ------------ ---------------------------------- ---------------!------------------------------------------------ _e00_ fI Remodeling and/or repairing (descTr_i&_):-_—__----------------------------------------------------------- 9 1 1 -----------------------••----- ---------------------w------------------------------------------------------- -----------------_-------------i------ ------------------------------------- ------------- ---------------------------------------------------------------- ---------------------------------------------- ------------------ ----------------------------------- -------- ---------------- -------- --------- ------- ----------------------------------------------------------------------------------------------------- ------- -- this application and that the work will be done in accordance with San Joaquin County 1�n ! hereby certify that I have prepared I ordinances, State laws, and rules ;d regulations of the San Joaquin Local Health District. I (Signed)-,---------------;---------- ------------------ ---------- --------- ---------------------------------------- ------ ---(Owner and/or Contractor) --------------------------------------------------------------------------------------- -- -------- (Plot plan, showing size of lot, location' of 'system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------7_r.R• REVIEWED BY------ ---------- ------------------------------------------------------- DATE- ------------------------ ------------ ----------------------------- ------------ ----- ------ BUILDING PERMIT ISS-UED_ ------------------------------ DATE-------------------------------------------------------------- - --- --- -- ---- Alterations and/;r recommendations: --------- - -------------------------------- DATE------------I—---------------------------------------------- ----------------- -------- ------------------- --�__ ------ ------ ----------- * ----------------------------------- ----------------- ----------- ------------ -------------------- -------------- --------------------------------- +. -------------------------- -- - ---------------------------------- ---------------------------------------- ------ - , --- ----1:_2 -------------------------- - ---- - --------- -- ------------- -----------------------7------ ------- ----------------- ------ ------------------------------I----------------------- ---- ---------- --- - _- --------- ------------- ------------------------------- ------------------------------------------------------------------ -------------------- ------- ------- -- ------- - --------------- - _-- ------ -------------- ---------------- ----------------- -------------- --------- ------------ ------------- FINAL INSPECT11 .7 Date------------- - -- -------- -- ---- 1601 E.Kaxeltan Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 SY-Camore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C L3.