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FUKOFFICE USE: --------------------------------------------------------- ----------------- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 4:3d_�_-2..4�. --------------- ----------------------------------------- (Complete in Duplicate) ------ This Permit Expires 1 Year From Date Issued Date Issued ___.__ ..... Applica#ion 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 comp' w' Countyr dinance o. 549. JOB ADDRESS AND LO ATION_..... e1 L1? i-- -- 111 - A aFAYA�-fo .. U�r~- i . +�.�-------------------------~- ------------------------ Ph ne-- ------------------------------- 9da�r1 ---------- - f�'e,�"'.0 ... iilur, ,�•C;...GT 4 -4 Contractor's Name---------------C:Y..iY_C` .F--,0......1Ak72%(1--Ff,)---------------------•-------------------------------- Phone.... Installation will serve: Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [:] Other ElNumber of living units: ---!-_. Number of bedrooms __yNumber of baths ----/ Lot size ._______''3 fir_'/ 0__________________________ Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table ld_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes V No ❑ FHA/VA: Yes ❑ No,K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_- -------Distance from o/un�dation__-_� __.._-_.Mater'L__ --_-*40 _____--_ No. of compartmems---�------------------Size--- Zl� 7------Liquid depth-------�----------- P y__-.Q _u�#' Ca acit _ ---.- Disposal Field: Distance from nearest IL__ ___-_Distance from foundatio (_ _________Distance to nearest log fine___-_ •-_______ � f Number of lines__________ Length of each line_______________________Width of trench____- - ,� a -7---- - Type of filter material�_____________e,4Depth of filter material______.4�-______Total length.__- -�_-_9�____-- Seepage Pit: Distance to nearest well------_---------------Distance from foundation--------------------Distance to nearest lot line--._-____________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h-----------------••-------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------....__.___.. ❑ Size: Diameter-------------------------------------Depth--------------------- ---------------------------._Liquid Capacity ------ afs. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.__.__.____________-_--__.___-.___-._. v ❑ Distance to nearest lot line-------------------------------------------------------- ----- Remodelin and/or repairing (describe):-----------`�`-'----------I9 -F-�- -C4--------t--O------F3�-----C=M L�_ .T ----------------- ---------- �-------•---- =-------- -------------------••------•-----------------------•------------------- --------------------------------•--------------------------------------------------------I------------------------•------------------------------------.------------------------------------••-----•-------------------------- -- -----------------------------------------------------------------------------------------•--------------------•---------------------------------•------•----•------------------------•-•- ----------------------------- 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 regulations of the San Joaquin Local Health District. r (Signed)-4--- �! ----------------------------- ------------------------------------•--------------------------------------------•------------------(Owner and/or Contractor) By:-------------- / -------------------------- Title ------------- -------------- (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--------------- ----------------- --------- REVIEWEDBY------------------------------------------------------------- ------------ ------------------------------------------ DATE----- - BUILDING PERMIT ISSUED------------- � - -•----•--------------- DATE------------------------------------ Alterations and/or recommendations---------------- ----------4.7------_-4 1----••-..Z2—_�-'------.�d-_ _--4�---------•--------------•--- -------------------------------- ---------------------- ------------------------------------------------------5-a—fI-rC----TAtJ-K-----------.K----------- 4 '�- -- ----- -------------------- -------------------------------------------------------------------•-•----------.....----------------------------------------- ---------- ----------- ----------------------------- -- -------- -- -- - ------------ ------ --- -------------- --- --- -1---- ----- - ---- ... __, FINAL INSPECT( ---- --- ---- ------ Date {J6� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Colifornla Lodi,California Manteca,California Tracy,California E9.9 REY18E0 9.89 F.P.00.2M 6.60 4 t