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FOR OFFICE USE: - ---------------------------- --------------------------- APPLICATION FOR SANITATION PERMIT -Permit No. --------------- -------------------------- ------------- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appfication.,.is-.made:in compliance kvith County Ordinance No. 549. JOB ADDRESS AND LO ATION.. f).T M S Cid' 'f Owner's Name---------------- + s/._..__/]Fo` ------ i¢-,--------------- --- --- ------------------------ Address-------------------------------------- ��,-------•-------------••---------------------------------------------------------------------------------------- ,-.----—..----- UF-7 Contractor's Name---d S" 5.......!S--` F!TT!G_----mil= S --`----------- tea- i y Phone----------------------------------- pRi A1R Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Traile Court E] Motel [:1 Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size __--- �_. _____________________.___ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table,4.0_ ft. V s. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe K Hardpan Previous Application Made: (If yes,date_....----_._--_-_.) No ❑ New Construction: Yes ❑ No 1Z FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifFed'if public sewer is'available`within 200 feet.) F Septic Tank: Distance from.nearest well_&0_.--_Distance from foundation__ /V-`--_:_.Material______ _______ _____________ ❑ No.of :coimpartments--=----"' .---=----..Size--f1_; __r-----,_ Liquid•dept`=-=-- - _�.�, 4 �.;-_Ca any-- 437 C-` I or Disposal Field: Di'#once from nearest well �l�1 . _0. Distance from foundation_____�_�-_.....Distance to nearest lot liri'e`►�Q�_-_ F-1Numberof lines-----------��_----____....__c Length of each line-__,_��,Q-----------------Width of trench---------- _-_____-___________ 701 Type of filter ,material--R��K---. Depth of--filter-materiaL___._-_1.17__:2 wTotal length___-_---_._.__/0-0..'........... ,: .414.. Seepage.Pit: Distance to nearest well /V� __-_-_-Distance from-foundation ..1 --------Distance to neares# IotTline__'__.--- .-..._ Number`of�rpits.... - Lining material_RQC1K_..._-.Size: Diameter _l.0._.__De th_Y: Cesspool: Di9tance -from dearest well_:_,__ Distance from foundation___._......:...... Lining material------ ,,,�� p Liquid Capac -----------_: ❑_ Size: Diameter-------------------------------------De Depth-------------------------- --- -- - from nearest building.-_-__._____-___________________________�� Privy; Distance from nearest st well _ = - Distance G ❑ Distance to nearest!lot Gne-____-------------------------------------- --- ----- -- -- f Remodelingand/or repairing (describef}: «f�-= c9 =---•�------ 2ZS/fca ---- -------- - W9----- A_7TlC�cr1A_5-----Mix; ► i4 t�-------0-�� F!!wI�----- VISMIlow;v'---~ y��" ^'�------�--- � _.._ .rte { _ S.Irk?------FOR------wasre-----K/_P—-----FDrv�, f ry CLAN ----------------------------------- ----------------------------- � .------ --------- ------------------------------------------------------------------------------------------------------------------- � I hereby certify that I have preps ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and �regrulations of the San Joaquin Local Health District. _ , V --------- n I (Signed)--- ---- ----- IC-4.1 -el i-.------------------------------------------- -----------------(Owner and/or Contractor) t - ABY.-,>. ----- ------•---•---•-------•=- ---- ------- ------ --- --t-- -- --------------------- - -----(Title)-- - �..��1�..•�..�.•�.e..r��--�.1�--�--'. _ (Plot plan, showing size of lot, location of syste in ion to wells, buildings, etc., can be placed'on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-. -7 ---9-------------------------------------------------------------------- DATE REVIEWEDBY------------------------------ --------------------- -------------- ----------- --- ----------------------- ------------------ DATE----------------- - BUILDING PERMIT ISSUED-------------------�-/------------------------------- -------------------------- ------------------- DATE-------------------------- Alterations and/orrecommendations:-:=:�- •-- ------- ----------.-- •-- �------------------_------ -- '-�---�---------.------•------------------ ----�----- -----------------------�---------------- --------- -------- ------�-- ----------------------------------------- -�------_------Y-' r`=--- ------ ---- ---- ------- -- ---- - ----------------------- FINAL INSPECTIO - ------ --- -- Date---------_-�✓.----z ----- ------------------- ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cafffornia Lodi, California Manteca,California Tracy,California F.P.Ca,