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-------------- --- ----------------- ----------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. I ----- --- -- .---- ------- (Complete in Duplicate) -- This Permit Expires 1 Year From Date Issued Date Issued i Application is hereby made to the San Joaquin Local Health District for ermit to construct and install the work here Thrs a lication is made in complia ce with County Ordinance No. 549. I�� Zsfall 2�k pp.n.. herein described. �3102 �5��,%dui-�� JOB ADDRESS AND LOC TIOVV Owner's NameRwoN ------------- - - - _----- --------------------- ------------------------------------ Phone- .-.� Address----------•------•-----��-��-----..�-•---�!I!}I/�-----��•_ - ---------R P�-N... Contractor's Name.. .-. --•-----.--• �l�a�.RC�1��351.N�..---••-�T1.1>�1 T�.l�:a----------`-�--- - - ---- ------------- Installation will serve: Residence ' F rl Cr i` ------------------- ----------- Phone.....---------------------- [ Apar+ment House ❑�i Commercial ❑ `Trailer Court ❑ Motel Number of living units: _.J. Numb?ufi,�, 3, . ,'7� +�k ❑ Other ❑ -- tibedrooms _.._.._- Number of baths Lot size Water Supply: Publics stem jj _Y ❑ Comms stem ,�/ -`--- ----- Y ❑ Private FI pepth to Water Table 2 ft. Character of soil to a depth of 3 feet: �OSand [Gravel F] Sandy Loafn Previous Application Made: (if yes, ❑••••-Clay Loam E] Cla dafe___________ --- _---- ) No Y El Adobe El Hardpan ❑ TYPE OF INSTALLATION AND SPEC�I�FICATIONS: New Construction, Yes ❑ No '�FHA/VA: Yes I� No ❑ ' (No septic tank or cesspool-permitfed-if public sewer-is available within,200 feet.). ` Septic Tank: Distance from nee est well----_-�- .. Distance from foundation_ -------_ Material-- Q_ r No. of compartments.._-._�_- - --•�----��'T,'�___-_-_-- ------Size.--Ve�Q-:Xdepfh--- Disposal Field: Distance from nearI, well-_ 0-r � -k a pacify--�z a_ Distance from {oundation-.-�4----------Disfance to nearest lot line----6; Number of lines-----1 . . `--------.Widt•'` - ---------.._.._Length of each line.._..IQQ- . Type of filter mate�ial_�0.C�_ ._..Depth of filter material--- _ y hof french --_ ---__ i O Total length �Q -------------- N Seepage Pit: Distance to ne4artst`,well.__---- --------------Distance from foundation------------------- Distance to nearest lot.line._...__-----_. � r Number of pits------�`---------- ---Lining material-..-- -- --- Size: Diameter._---.j -+ + ----- Deptn_..-_. I Cess ool: I„ - - � _ ---___- . -- ❑P Distance fi-om nearest well_.-----._-._---.Distance from foundation_________________.L.ining�material.__---._.--•-,-.: Size: Diameter..__---+r__-.____ - ` i •----- ------ eptly----- ------ ----------------------------------- ---Ei uidlCa au —. ,------� Privy: Distance from near`�st well---------------------- q p tY --------------.-�.---gals. 1. --------------Distance from nearest building-----------------__---------'`1--------- ❑ Distance to nearesf�;lot line--------------------____ ------------------------------------------ ------ !'`= ----- - Remodeling and/or repairing (describe.)----_----�1GP1--F# 11 ---------------------Ta.� -------- -------------------------- ---------- -t ---------- 7 H-------------------------------------------------------------------------•----- I_----------------------------------------- # I hereby certify that i have prepared this application and that th `.york will 6e done in accordance with San Joaquin County ordinances, State laws, d rules and regulations f th San Joagn Lbcal Health District. (Signed)------ ------------------------------- - --(Owner and/or Contracto, ;c } �S (Plat plan, showing sizeof lot, 10 ation of system in relation to wells, buildings, etc., can be placed on,'reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY----- r - REVIEWED BY----------------- - - - -- DATE BUILDING PERMIT ISSUED - ------ ------- -- ---------------------------------- ---------_. DATE. f Alterations and/or-recommendations:_..--_----:— . = _ '=`=-== - = -- I- ----- -•------------------------ -------•------ - _. -- ------------ -- ------------------------------------�.. r I(,(i y --------------------------------------------------------- FINAL fNSPEC - - Date_-. J1.: _7� 4 , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. r 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 91h Street F.P.0 O. Manteca,California Tracy,California .i"" -