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1,01`FXE USE: --------------------- ---- ---------- -------- -------------------------- --------- ------------------- APPI_16AfION FOR SANITATION PERMIT Permit No. ------ --------------------------------- ----- (Complete in Duplicate) ----- --I------------------------------- This Permit Expires I Year From Date Issued -3<3 0 �!-�=_�Date Issued .. Application is hereby made to the San Joaquin Local Health Distritt for a permit to construct and lnstall the work herein described, This application is made in compliance with County Ordinance No' S49. JOB ADDRESS AIJD, LOCATION JX7_ ------- ---------47------ Owner's Name----- ----------- ------- RM------------•—•----------------- ------ ....Phone--- ----------------------------- o Address-----R-Ta- ------- 19 K-------IS06-------_---__-_44T. H.R-119, 17.1----^--------------------------------------- " -- Contractor's Name-jOWA65K-.1 --- ----Z: 01 --------------------------- - ------ -- pholmd ------ --•--------- Installation -_------------- Installation will serve: Residence El Apartment House [] Commercial d Trailer Gvml ETO"M ofel E] Other 0 Number of living units: __1---- Number Of bedrooms _��Number\of ba1t's._/_r___.Lot�size, ------------------ Water Supply: Public system E] Community system'[] Private W Depth to Wafer Table11 ft. Character of soil to a depth of 3 feet: Sand -Gravel 0 Sandy Loam Eq Clay Loam E] ICIgy El Adobe E] Hardpan ❑ Previous Applicaf ion_Made:_(If..yes,,d ate No �ew-Construction.: Ye,.E-__N. No E❑] FHA/VA: Yes E] TYPE OF INSTALLATION AND SPECIFICATIONS: (tio septic it+ d if,public se ri5dy.aiIa6Iewxfh;n 2()0- - we_ _ fedt Sepf;c:-0: Distance from nearest well-----5 ___Distance from foundation----/0�-_..,MaferiaL__-.CSI. IR-97 Tf—�:Z No. of compartm'enf5------1��-----.--Size -0prot. Liquid depth__.,_ -,r_ Capacify__2- I A Z- ---/11,0i 5---- Disposal Field: Distance from nearest Wf I I.._.SIP D iXbn cl from f6und at i on-----/0--------D i sfa n'ce to nea rest�I at-1 i n a- Number of lines.------- ----------Length ofVct "FT-------76649-4—.-Wiclth of,trench......3161" t., 1 1. A ----------?�-------- Type of filter`materia1_.__?�b. _Depth of filferrM. rial------ /a.If ate 14- --------Total le6gfh-------------1_/0_a--------------! C, Seepage Pit: Distance to nearest well--------------- -----Distance frorriffoundafion--------------------Distance to nearest lot line---- A' n Number of$ifs__!------------ - ----Lining material------ ---- Diameter---------- -- ........-.Depfk---------------r----------------- ' Y Cesspool: Distance f"on,7 nearest well-------------___Distance from foundation._:__.._'.____ Lining material__-....--__------_-.----.----____-_. -?�' 171 Size: DiameterDepth--------------------------- -' -------------------: I --/ -- ---------- --------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well--------------- - ----------------------I--------Distance from nearest building__.._.____.______________--____--.------.. ❑ Distance fo" "'n4earest-lot line_'_._)i----------------------.............. ---------------------- Remodeling and/or repairing (describe):---------------------------------- -------------- ------------ --------------------------------*-- ----------------------------- ------------ --------- - A - -------------------------------------------------------------;---------------------------------------------------------------------------1; -------------I-------I'll-------------------------------------------------------_ 7V --------------------------------------------I----------------;-------------------------------------------------------------------------------------:---------------------------------------------I------------------------------ 0 i . - t> ------------------------ ----------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ --- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health Disfrid. (Sign -- --------- -------- --- --------- ---------- ---------- --------------------•- ------------- -------::-�.(Owner-and/or-Contracfor) --- ------- - --- ------ -----------------I------ -----------(Title)---------------------------- ---------------------------------- (PI W47 plan showing- -- si 0f I -o-caf;on osystemtnreKXo_n.-"To-w—ells.—ITuildin-4s-re-l-c�,-ca—n 156-placed-06-reyerse-side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ 17'1 T ----------------- -' 1_7 ----------- -------------------- --------------------- DATE -------- REVIEWEDBY------------------------- ------- ------------------------------------ -------------------• DATE----------- BUILDING PERMIT ISSUED-----•--------- ------------------------------------------------------V----- -------------------. DATE------------7 Alterations arid/or recommendations:---------------------------------------------------------------1_4--------------------------------------------I------ 7 'r -------------- ---r_W_A_NCe D ------------ R-C - -------------- ---------- -- ------- ------- ---------------------- ----------------------------------------------------------------------------------------------------------------- �7.7_CTR=...... r-- --------e-.-K--------------------r1f Acj:...I r -----------/ ----------- ------ ---------- -------------- ..... .... -----. ------ ------------- ------------------ - - - --- ------------------------------- ------------------------- ----------------------------------------------------------- FINXL INSPECT]( BY Date.... /4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 'I-- 0 F.P.00.