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FVK OFFICE USE: —-- r --------- --------_----- ------F___._ .__ - APPLICATION FOR SANITATION PERMIT Permit No. ___. -_ ---- x -__t =:---- ---- -------- (Complete-in Duplicate) ._.,.._-------------'-"-.---- a-------------------- This Permit Expires 1 Year•:From,Dateassued'a Date Issued _ t � �-- DIO p5 ,�_ _ _ Application is-hereby madeto the San Joaquin Locaf Health District fora permit to construct and install the work herein described. This application is made in,co m plliiance with County Ordinance No. 549. ' 7-S f r0 r S�c9 ti JOB ADDRESS-AND LOCATIO _.w-pg,------ pul5-lame ! R Owner's Name:______ ------ ------ Phone.. Address-__--_:-•.-- Contractor's,_Name------Q_ T l :-- Phone Installation w ,;,- 'ill-serve: Residence 3 Apartment House E] ------ Commercial E] Trailer Court Motel 6 Other E3 um �+ Number of living units: _-T N 'tier of bedrooms Number of baths . __ Lot size _ / _C.REA_C�I---_------.- Water Supply:. Public sys em ❑ pCom�lJMuCnity slstem [" Private ❑ Depth to Water Table ;+ Tft _ cT i V Character of sail to a dep#h:of 3 feet- San Gravel 0 Sandy Loam ❑ Clay Loam'❑ ;Clay❑: Adobe ❑ Hardpan ❑ Tl ; Previous Application Made: jllf yes,date-..._ I No , New Construction: Yes w`No ❑'' FHAfVA: Yes ❑ No 6 — TYPE OF NSTAMA`TIO N;ANlJ SPECIFICATIONS:' 7; - ymow (No septic tank or cesspool permi}ted if public sewer is available within 200 feet.) "" p . ... r. Se T k: Distance from nearest-«weft..... ... ...Dis}anee from foundation__._ _ artment -----i--.Mater i .CCS lei - No. of com s._,_!_.- p Size. Xl�� X Liquid depths= ._ ,Capacity.j7p ------ Disposal Field:-; Distance from nearestt well----$-----Distance from foundation------ -----}-.Dis•tance tb nearest lot line__5�..____ Number of lines.__.__._;.,,{ ----------- -------Length of each line__._�;~'�f __.._ ._ t Width'of ttenah...... _ _______ _ .r Type of filter ma#enal 1_0Ga� Depth of filter material___._1_ ..l� -Total length_ _..___ r; ------------------------------- Seepage D© `-------- --- See a e Pj:,i efk �� . p q Distance to nearest well_ �..._ ._`...___Distance from foundation._____________ _ _`Distance to.mearest lot line__._-._____.___._ ty Number of pits--- ----------------.-Lining material---'-�" --' - -. Size: Diameter-_�_�7--'__-._-f__4Depfk------------- ----- "ter { f r +^ Cesspool:,r Distance from nearest well ____..._ ------ from foundation_________________ __'Lining material.._.____________.._ ---------------- Size: Diameter- - ------ = ---- ---•------Depth_----------------------------------------- ---------Liquid 'CapacitY----------------------------gals. Privy: Distance from neares'�well_....______...._ _______________________________Distance from nearest ------ ❑ ,- Distance to nearest lo.f.line _..................... . . z f RemodeIin " and/or repairing (elescnbef i»__.-___-- _ ..__. _-__.-....___.-._________________________________________.__2i ------ ---------'•-----r;='=�' - 1. _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'regulattons`of `lie San Joaquin Local Health District. =% (Signed)_ 6 f � I 1 l`� J Jj —*ems ,..3�, -. - (.Owner. nd/or Contractor) I/ a BY� r .......� v - I (rtle)'._.IA1a�Ti (Plot plan,. showing size of lot, locafior�-_ofsy ',m in:r,,I tion to wells, buildings, etc., can be placed on•reverse side). << x i ►' FOR UEPARTMENT-USE_ONLY{ f, F� APPLICATIO.M ACCEPTED BY `�_FS - --- ------------------ ---------------------------- --------------------- ------------------ -------------------'------ DATE_;_. `' = - ------------------------------ BUILDING PERMIT ISSUED---------------- _ 4i ---------- ' ' DATE `-------i--=;�--- Alterations and/or recommendations__ ______________'. _. si ' 1 i. fr' _._._____. ------------------------------.__ _________________________ - ei iit ' rr--- -------- ' --- s' .......................................... ---. A FINAL INSPE r` Date--- ---------- rr i1to I'Z--- ------------------ ------- SAN'i"JOAQU,lN LOCAL HEALTH DISTRICT 1601 E.lfazelton Ari. 3DAV st-ok Slee 124 Sycamore Street f_f � 205 West 9th Street Stockton;ealifoinia Lodi, alifornia Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Prem "`4