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t-UK Ul-HC:E u5E: ---------------------- --------------------------------- __..__.______________________________________________- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------- (Complete in Duplicate) ------------------------ This. Permit Expires 1 Year From Date.Issued Date Issued Application is hereby made "e San-rJoaquin-Local--Healfh Disfrict for a permit-to construct and install the work herein described. This applic�ation�is made in compi ce with-County Ordinance No. 549. I JOB ADDRESS AND LOCAT ON__ _ f .___.___-Rlt o -______ __--__-...... l PON [� 1_ Owners Name------------- - A47-ER.-------17 ` -- -M r -------------- ------ Phone -- ---- a I Address----------------1p�-�•--�-� K---------166 rpar�----------------------------- ( ' ..._ � ? t A ------------------- t1. � --__--- ----- ' ------i-.. Contractor's Name------ANT1IQa+�----�__50V ----- ------- f---- -------------- Phone-----------------------------'� - -------------------- Installation will serve: :Residence ff`Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I. ! Number of livingunits: __ ____ Number of bedroom - s, ____ Number of baths_ -__, Lotsrze '__ Water Supply: Public sykirn ❑ Communesystem ❑ Private"®` Depth to Wafer Table/�__ ft. %. _ ,.. Character of soil to a depth of 3 feet: Sand [/�Gr el ❑ Sendy Loam ❑ Clay Loa ❑ Clay ❑ Adobe ❑ Hardpari�❑ Previous Application.Made:�_ll.f__ye ,date_...____ `,',. _..),,�No �ew Construction: Yes ❑ No [ FHA/VA: Yes [>7�Nol❑ 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__.__.�7_<2----Distance.from foundation----1 !--.-.Material---- F_7E-____ a i.k No. of compartments------'�---------------size l-_x��x-`�-- `-- Liquid depth---- Z.r--------Capacity--_1Z_0 Q, � � Disposal Field: Distance from nearest well..r..��_- Distance from foundation__-/p��__-_-Distance to nearest'•lot line__. ❑� Number of lines=_______ ��________ _________fLen th of each line__' �" : � °` g ---... .�----t;�-----Width of trench------"./,'---------- - Type of filter material__gDcK------:Depth of filter material-----Irtajt----Total length------------ z> Seepage Pit: ZDistance tothear'est well---------- _.__._'___Distance from foundation--------------------Distance to nearest�Iot line______.___ ❑ Number.o.f pits----- --------------Lining€ material----------------------.Size: Diameter----- -----------------Depth--%a__...._._-__-- ----- �� Cesspool: Distance from nearest well_________-I....Distance from foundation------------ material_________--__-._--- _ i�----' ❑ Size: Diameter--------- --------------- ----Depth------------------------ _ Li uid Ca acit I r i ------------------i -- G Capacity_ - 9, s. Privy: Distance from nearest well___.1.� `___-- ____ ---------------------- from,.neares. building__._______.___________________._____ ❑ Distance to nearest lot line----f t__._ ) ' E ----------------- ------------------- ----------,=------------'-----------------------------------------------------=----j Remodelin and or re airin describe :____-_ , / � g / P g t ) -, P�Jgr_J k_1 ST146 � ->;rnnM-------TZ?....MAK-c------11 ------------ ----------------- �D551_FL�. 1-T�,'Y__------- ,�:�c y -fi3lil A ---"�=--az AT I` =ER ----------------------- -- =' --------- . _ :- ' --- ------------------------------------------------------------- I_` i -------------------------- I hereby certify that I have prepared this application an "#fiat'fhe workwiil be-done-in accordance with San Joaquin County I ordinances, State laws, 'and'rules,and regulations of the San Joa uin '-*'` f g q �Loca}=Healfh I]istric+- )Signed) --- ----------------------------------------- ------------------------ -------------(Owner and/or Confraclor):. e_-, By:------- - t -- ----- ----- - --------------7-1- -------------------------------- ------------. Title y --------------- - ------------------ ---- flof; V (Plot plan, showing size oloc on_of--system fn.relation,fo wells, buildings, can be pliafed on reverse side). FbK DEPARTMENT USE ONLY $ APPLICATION ACCEPTED BY--- .- - ------ ------------------ ------------------------------------- DAT ---------_��7,--7/ L REVIEWED BY ------------------`--------- -------------------------- ------------------------------ DATE-`--------- , BUILDINGPERMIT ISSUED--------------------------------------------------------------------`------------------------------- DATE-d---•----------------- ---'---- Alterations-and/or recommendations:______..__._ , -- • �. .__1 .. -•-� _ . _- - -------------------------- ------------ -------- ---------------------•----------------------------------------- ---------------- ---------------- - r t I a" w•`! I !f. --------------------------------------------------------- --------------------------------------------- ------------------ ------------------- ------- --------------------- ------------------- -------- ---------------------- - = r - -- ---------------------- --------------------------------------- I FINAL INSPECTIONjDate----------------- � � -4b `• SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street i3 Stockton,California Lodi, California Manteca, California Tracy,California F.P.C O.