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' FOR OFFICE USE: i-i* = --------------------------------------------------------- � /6 7ti! ______________ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . l. ----------I.'---------- ----- ------ .(Complete in Duplicate) This Permit Expires_1 Year From Date Issued Date Issued l Application 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 com pl iance-with-Gounty Ordinance No. 549. E A4)9 -raC_fl 'ADDRESS AND LOATIrONQ , I ,.* �o �FJOB :-- - -----A / 12 Owner's Name_::___ - Rl - l7} .QU14� - -----------=----------------------------- Phone------------------------------------ . Q Address---------------R ��" -_13_X-------r1"0------h-------- MA_N� -ci)----------------------------------------------------------------------------.--- Contractor's Name-------Q_lA. _I ------•-------•-----------------------•------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence e'� Apartment House ❑ Commercial.❑ Trailer Court ❑ -Motel ❑ Other ❑ Number of living units___ .___ Number of bedrooms __-31 ANurnber-of.-bathsr -4L-ot sizes_T-t�_6�------------------________ Water Supply: Public system ❑ . Community system ❑ . Private(� Depth to`1Nater Table la ft.� I Character of soil to a depth of 3 feet:, Sand E] Gravel ❑ Sandy Loam 0 Clay Loam [t �Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date/9-"31'_b3_) No ❑ New Construction: Yes ---No ❑ FHA/VA: Yes ❑ Nog- -- _..TYPE=OF INSTALLATION.:.ANDTSPECIFICATIONS: I-x'76 ',. �...� -- ' _-- - � T - - - ---moo^^- - ems...--•.- =��,Y._ �..�� ,.,i (No septic tank'or cesspool permitted if public sewer-iss-available within 200 feet:) Septic Tank: Distance from nearest welL__y�0-_____Distance from foundation-----/Q--------Material=_!:QN_C-RCT��. No. of compartments----.--2-- --Size_,-3.x-�_X5 -----Liquid depth----y��- ------Capacity------9©Q-- Disposal Field: Distance .from nearest well..... �_.__.Distan-a from foundation_____/_Q__.___..Distance to nearest lot line_�� _____ Number of lines=---- ---------- ------------Length of each line_. /= ,-- -�---Wic14 offrench------1-�}-------------------- Type of filter material---13o c K_____Depth ofrtfilter material-'fk ,9- -Tofal letngth_________�"119L �________f___._ K Seepage Pit: Distance-to nearest well-----------------------Distant e,from.,foundation__________________Distanc to nearest lot line----------------- ❑ Number of pits-------------------.Lining material! Diameter------ = -_.- _-.Depth-------------_--------__--re t �. Cesspool: Distance from nearest well_________________- Dista� i ul ce from #oundation_--_,_.-_-__-_____Li�ng matenaL_._______.i______.----------------- Size: Diameter- ---_-_-- -- - `_De th---------------------------- ---_Luid Capacity_ ❑ p q -------------------------gals. vv-- Privy: .. _ Distance from nearest well -------------------------�-__-----------..-Distance from nearest building____________________________________.___. _ ❑ Distance to nearest lot line ::, ------•--- ---------:--------- -------------------- �i[r[.r.�.� } __ - __--.___-____________________________________ __ f Remodeling and/or repairing (describe}: ------ - i-. -- - - - .---.• ltl4t .•-- 4 t t .. �• T = :, , ---- -------=--------------------------------t----------------- ------------------- I hereby certify that I have prepared this application%nd that the-work will 6e done in accordance with San Joaquin County ordinances, Sta a laws-and r s and r9quiations of the Sai Joaquin Local Health District. (Signed)-------- -- :- ------- --- ---------------------------11--------- ------------ -----------------•---- --•--------------- {Owner and/or Contractor) „ ...r �.. �� ., •�. _ tt_7-4-- '�_.o F .... ..,... -- `.—��`�`;-8�=---------------------- --------------------�`-`y------------------------`�- -----==-----�--�'.”`=-Title --------- - ----- (Plot plan,_showing size of lot, location of system' in.relation tolwells;,buildings, etc., can be placed on reverse side). r t� - I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------— - -------------------------I---------------------------------------- DATE--------- REVIEWEDBY ----------------------------------------------------------------------------------------------------------- DATE------------------------------ -- BUILDING+ERMIT-ISSUED_-------=---I----- DATE ' Alterations and/or recommendations----------- ---------------- -------- --- ---- --------------------------------------------------------------•--------------------•---------- -....----------- - ---------••--- ___________________________________________________________ ____ , _......._....f ___-. ...__ .__.__- --_ __.____._-_-_________________________ ._____,y __ _ _ ---------------------------------------------.---------------------------------------------____. _.-_._----------------------- F ____'._________ ff __ F._ F1NAL INSPECTION BY: s Date------------ ". �� T~ � r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 f.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street _ Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-s9 am a-ao F.P.ca. i a