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FUR OFFICE USE: -------------------------- ----------- ------------- ------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. ..._l d- ----- (Complete in Duplicate) r Lrtit rs,Wr4 cl><' This.permit Ex Tres 1°Year From Date Issued fi. 7 - --4 Date Issued ----�- -- �2,o2-Zan-o," Application is hereby made to the San Joaquin Local Health Disfricf for a permit to construct and install the work herein described. This application is ma "in compliance with"Court Ordinance iN-0-`549.— -j C 1.._ �t JOB ADDRESS AND LOCATION___.__ _ � //�� Owner's Name LYl_ , �- rl �-�_ - l: I�---- C7--fC��-- { Phone Address---------9FO-��-• ---�_I .Po(3�--_lr(dA�_-------- Contractor's Name-------FLLF—.R{, s _ Phone... -------------- Residence A artment HouseA ; p ❑`'�.Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unite+./_------ Number of bedrooms _.�-1 umber of baths Lot size __ _ ____ 7 - --------------------------------------- V, 3 •--------------------------- Water Supply: Public system)❑ Community system ❑ Pri#at' Depth to Water Table ft, Character of soil to a depth of 3 fe4f: Sand gq--Gravel E:]] Sandy Loam ElClay Loam ElClay Adobe ElHardpan ElPrevious Application Made: If yes date____--._.,,_._--.) NoiT�Iew Construction: Yes o ❑ FHA/VA: Yes P}�No ❑ TYPE OF INSTALLATION-AND SPECIFI,CATlONS: {' (No�septic.rtank_or-cesspool-permit-Fedrif;.public sewer,is-available-within-200-feet) - - Septic Tank: Distance from nearest well-_,5. --Distance fro fondation__ Mat --�M No. of compartments__- --------------Si2e--_- ......�/ de ! � :-�--.-Q---Capacity-- ------- �T.Liquid pfh- r� �} O©-©_ Disposal.Field: Distance from nearest well.-. 0___Distance from foundation---- ------Distance to nearest lot line----_� I"Il Number of'lines---------- -----------------Length of'each I,ine_�p--'SCS •d /r - - - �Q.W.i th`of trench------ -�--------•-- ----- T e of filter material_-jyvC- �r �+ Yp --._ Depth of filter.• materlaL__1 _-_.___.-__Total length__-_ d___'_____---__ r /1/ ---------- 'Seepage .Pit: Distance to nearest well r��- • Distance from foundation___ ._.Distance to nearest lot line---- - O Number of Cess: Distance fromsnearest well___ g ( -- Depth__..,----- — p - _ _..._ Lmin maferial OC/,- _.SlZt : Diameter. ----------- __.__--_-Distanc from foundation__--__----. Lining:material----------- ❑ Size: Diameter--- --------------------------- -Depth-1--- - ------------- - --- Liquid'�Capacify-------------- ------------gals. Privy: D'++stance from niaa�est well"""""""""-.- -- ----------- -------__-__-.._Distance from nearest building--_.---------.---_-_-------- - � Distance to nearest lot line_"% -:,�+ f '�f��_---- r�_ ---_-�s. V - --- Remodeling and/or repairing (describe_-------------------- .--------------- -------- i t ------------ -- _.--------------------------------------- �a - - - -------------------- ----------------------------------------------- - - 4 ; ..hereb certifyfhaf,I.have, reared this application andAa#-.the work will,be-done�in accordance with San Joaquin County ordinances, Stafe ws, and rules and r a#ions of the San Joaquin Local Health District. ; (Signed------------------ i . ------------------------------------------------------------------------- ------------------------(Owner and/.or Contractor) By:- . --�� ; -Y---,��-...._.,..:- - ---(Title)---------------- --------------------------- W,(Plot plan; shong size of lot, location of system in relafian t�o wells,'buildings, eb fccan b p aced on reverse side): r � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------7—, .,- -------------------- - DATE___- t - -------------------------------- REVIEWEDBY------------- ------------------------------ ---- --------- -- .`DATE - ------- ------ - -------------- --------------:-- --- fLDING.,PERMIT.ISSUED ` ------------------- =---------------- -------------------------------= -9.ATE--------------------- --- ---------- A!#erations and/or ,.�.,,� ..,--q-�..r_ �, ,",..,...,...�._ -----•-------- ----------------------- --------- r - - '1 art_.. h�J4�JK.►�lA_f� ------------------------ - ------ --------- H i^fG A --------'�'- �n.i�.----=------- L0._ Z ° � Off- TS r� ' A>= -t-0 P d FINAL INSPECTION BY:---- J Date / ."� J .. SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. w