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FOR OFFICE USE: f -- ------------ .�-.�/) --- - �. _--�6---- ----------- _.__-_-.__ ____. APPLICATION FOR SANITATION PERMIT Permit No. _ q �p (Complete-in Duplicate) �f ` - Date Issued �s._!_- .� This Permit Ex ires 7 Year From Date Issued , r / k-(-070 --o/ Application is hereby made to the San Joaquin Local Health District for a ermit to constru t and i�shall the ork h rei described. This application is-made. in_com fiance_-with Count Ordinance No. 549. , Y ,. ._ P y S`'°cLc j1L�11�. lc% ?c1,.lol�IE' k-1 JOB ADDRESS AND LOCAT ON. -.- ---- s_x_y1�,�f• acf . - - .-_F._- . Owners Name_.__`--1' Q-r!�-� 4 -910091 Address--------- >G!_27-991>/+� i/� --- ------------------------------------•-------------------------- Contractor's Name__- ______ N OT . Installation will serve: ResidenceJN Apartment House Commercial Trailer Court El Mote ❑ Other ❑ Number of living units___ Number of bedrooms--,3-- Number of baths___ Lot size __a /- ----- ---------- ----------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table SP_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,dote./_96. .____/-No New Construction: Yes ❑ No 9?-_'FHA/VA: Yes ❑ No E] I,– TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �V S is Ta Distance from nearest well--------------___Distance from foundation-------------------- No. of compartments--------------------------Size------------------- -- -•--:Liquiddept`---- ---------------__ -Capacity------------,--„--��-- lh Da sal ipJd Distance from nearest well._ _ --.-Distance from foundation__---�------Distance to nearest lot line. Number of lines__ ._- _ } Length of each line..____ p______ .. Width of french_--. ____ ____�_` -___-----.- .,�. Type of filter materia �_4-(_- __De---Depth of filter materiaL_______�_ ..� ` P Total length---------------1�'------------------ Type --------- - '1 I � - j• S �aqePif: Distance to nearest welf.. t_p__p.-.-.-__Distance rom oundation-----t-9- __--.Distance to nearest lot line_.f__7X Number of pits.-I-I-________________Lining maferial__� _c[:-----Size: Diameter._.-__`- .. .. ii �`` Depth._.. ------------------ yl Cesspool: Distance from nearest well-----------------Distance from foundation__.....--_----.--..Lining material__----------------------------------- ' _.._________ f --------------------- s ❑ Size: Qiameter_.i----------------- ---------------Depth---------- -------------------- --------------------Liquid Capacity ..-- --------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building 9 ----------- -------- ❑ fi Distance to nearest lot line ------------- ----------------------------------------------------- Remodeling and/or repairing [describe]:____.__ f I _ -----------------------------•------------------------------- --- � - - - _f - - -1-� L �?----------- -------------- --- --------------------------------------------------------------- . --------------------------------------------------------------------------------------------------------------------------------------------------- --------- - a I herebycertify that have t y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, art ules and regulations of th an aquin Loc Health istrict. 2' i (Signed)-------fiEl�`i'IC YANKEFit[C /y Contractor) BY - 15 _384i Contractor)y --- L� Title_ -------------------------------------- - (Pot plan, showing size of lot, location of system in relay n to wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY =' - DATE S 6s"”' REV - 1 IEWG BY_----- IS -- E ------- ----- -- DATE-------- --------------------------- ----------------------- BUILDING BY ISSUED------ ------- ----------------- DATE Alterations and/or recom endations:-°---- -----------•-------- ' ----- ; FINAL INSPECTION BY:------- - ------ ----------------------------- Date------4�- e 7z-o - F [ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street �+ Stockton,California Lodi,California Manteca,California Tracy,California