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FOR OFFICE USE:- -------------------:---------------------- .SE:.-------------------=---------------------- - -- , APPLICATION FOR SANITATION PERMIT Permit No. t --------=----- ------------ (Complete in Duplicetej - - -------------------- _ Date Issued ----.__-__ -_---__-_------___.___ This Permit Expires 1 Year From Date Issued l Application is hereby made to the San.Joaquin,Local-,Health District fora permit to construct and install the work herein described. R This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND-LOCATION----------------l__9 ] -------------L-V _ 1-1 sr---- T_C '- Owner's Name------- --- •-FRF} - A-RDIM------------------- Phone. Address..-------------------- LV-----------I0--------- 4'1_N.cQ_---if-v__--------• C1�}.. = Contractor's Name---------- --------------------------------------------------------{--------------------------- ------- Phone------- •-•---- ---------•- Installation will serve: Residence [:1 Apartment House E] Commercial El, Trai4er Court El ' Motel [:1 Other r,AS k 3 / Number of living units: -------- Number of bedrooms -------- Number of_baths -------- Lot size ---------f. QO4-__:R--------f—------------ J ft. Water Supply: Public,system ❑ _ Community system ❑ Private Depth to Water Table 1 Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand .Loam ❑ Clay Loam ❑ Cl y ❑ Adobe ❑ Hardpan ❑ __;Pce-v_ious�_Ap.plicationrMade_::�(Ifryes,_ciatt---,__, -- 1d;No� w Coostruc#ion.: -Y_es �No E1,_ FNA/,VA:,Yes.❑� No_��r� TYPE OF INSTALLATION 'AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic Tank: Distance from nearest well-----------------Distance from foundation_-_-_______---___..Material__-___--___________----____--------_-_-_-______- compartments--------------------------Size--------------------------,-----Liquid depth-A ------------------Capacity--•-------------------- . 1 Disposal Field: Distance from nearest well-__e -...-Distance from foundation___- sfance to nearest lot title____ __________ ,. �r Number�of lines__r______//---------------------Length of each line----l_ ___- -Width of trench.-__. Type of filter material-_-_ 0.C-K_----Depth of filter material----20?__ -------Total length--------1_5_1____.--.•_----------------- Seepage Pit: Distance to nearest well ___-_-_____. --------Distance from foundation--------------------Distance to nearest lot line,-.----_____._.__ 6 ❑ .Number of pits--- -----------------Lining material--_--------------------Size: Diameter-----------------------Depth----------------------- --- --- I --fi�rr Cesspool: it Distance from nearest well-----------_------Distance from foundation-------------------.Lining material---------------------------.---------- F ❑ - ,Size: Diameter---} -------=-------- ---------------Depth--------------------- -------- --------------------Liquid Capacity------------- --- ------=---gals. PrivyPrivi _ Distance from nearest -- --------- --------------------------------------- ----------------------------------------------- ---------------- IJ y : z ; Distance to nearest otVline--,,l ' _z Distance from nearest building �+ � • • -t� . - °-- x-`-E-�-- - --=-��''--mss-----------�------ � 1 Remodeling and/or repairing (describe)_ _TF.M�-_-----� ..ST�M;I______T� � 5o NJEfi'-'E 'Trlaryp5anl p PRaPos�t?-----6---- 4 �T�nfi�� 5,yST�M---r------ 1 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, an rules and regulations of the San Jo uin Local Health District. (Signed}= ---------------------------------------- - - -[.Owner_and/.or_Contractorj : Plot plan. showing size of lot, location of system to relation to wells, buildings, etc., can bieleplaced on reverse side). ` P g y FOR DEPARTMENT USE ONLY _` ' APPLICATION P,CCEPTED BY-----�t-�--' --- - --------- ---------------------- --------------------- DATE__R-�-- ----------- -------- -- REVIEWEDBY = - - ------- --------------------------- ---------------------------------------------------- DATE------------------------------------------- ----------- -.-- BUILDINGPERMIT ISSUED--------------------------------------------------------------- -------------------------------------DATE--------------------------------------------- --------------- Alterationsand/or recommendations:` -------------------- -------, .......--------------------------------------------------------------------------------------------------------------- - -------------------------- -----;---- ---- -----------------------=--- ;--------------------- ------- ---- '----------------------------------------- ------------- - ------------------------ FINAL INSPEC :. ----------- Date-_ -----------�'- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91hStreet t Stockton,California Lodi, California . a Manteca,California Tracy,California F.P.C O.