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FOR OFFICE USE: F fl - 0-7r)Lt'7 ------------------------ ----------- - -- ---------- -- .._.. ,_-_.---..________________ _____________ APPLICATION FOR SANITATION PERMIT Permit No. __ _ _1ZT___ --------------------- ------ (Complete-in Duplicate) f- G Date Issued _---.....___ __ ___ _ _ _____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County OrdinaQnce,No. 5,,49.. JOB ADDRESS AND LOCATION..__77 AI47 5_7_7 A/-----6-r T� TH r� Owner's Name _(- L I r, CT/a-IV.-------CQ--- -------------- Phone-- 22 2 Address------------------R-Q-- D!2x~ - /—f H_RO .-'- Contractor's Name------L-RR .:-_ F447EK--------- ------ Phone------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: __ ----- umber of bedrooms_.. Number of baths �- Lot size _-._l0®._.-.X__r_��-------.__ ---•----------- Water Supply: Pub€ic system Community system ❑ Private ❑ Depth to. Water Table t. ft Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date............. _--- ) No Zj-_'_New Construction: Yes <❑ FHA/VA: Yes2---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .__(No-septic_tank.or_cesspool permifted,if.public sewer is available within.200_feet.) Septic T Distance from nearest well..CLW.Distance from foundation-_ 0-_.-.--...Material .00-C.KIfTZI--_ No. of compartments-._- _----------Size___'Y_X_LP_X--5,___Liquid depth----X/�.�_-_ Capacify-_I-'-7_.p.......... Disposal,Weld: Distance from nearest well--<::%W_Distance from foundation-----A ---------Distance to nearest lot line.__.__.__... • Number of lines -----:9=-------------------Length of each line/6d5___ (9_ '__?. Width of trench.-__..� _ Type of filter materiai._R0_C•K_-._.Depth of filter material--- length---------------1. ..- Seepage Pit: Distance to nearest well------------ _ ------Distance from foundation-------------_--- Distance to nearest lot line--._-___.__----_ ❑ Number of pits.-- ------------------Lining material----_-------------- Size: Diameter----------------- -----Depth_-------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation................- ..Lining material-...-___-.----_--.-._---.._.--_-_-_-- � ElSize: Diameter- -- ------- ------ ----------------Depth------- -------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest Wel!----'--------------------------------------- --Distance from nearest building---_---._--_---J--------.-_-_.-.-_----. ❑ Distance to nearest lot line----------------------------- F_ -------------------------- - Remodeling and/or repairing (describe�_..1` _N--R_____.-Q �. 9-3_ ----------------------------------------------- ---- --------------- -------------------•------------------------------------------------------------------- - ------------------------------------------------------ ----- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- ----------------------------------------- - - - - --------_---------------- ------- --- ---- -----------•------------ -------- (Owner and/or Contractor) BY= V_ -- -.- --- -------- ------ :------F_e�.=- --•---:------------ =- _ .......... ---------- ...... (Plot plan, showing a of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F bEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---------- --- -- --- ------ ------ ------ - ----- DATE------� S7_.`-_67-- REVIEWEDBY---- ---------- ---------------------------------------------_ ------ --------------------------------------------------- DATE------------------------ BUILDING PERMIT ISSUED-------- -- --------------------------- -------- -------------------- --------------------- ------- DATE Alterations and/or recommendations:---------------- - __ ---------------------------- ----------- ----------------------------------------- 1-- ----- ---- -------------------------------- ------------ ---- ------------------------------ -------------------------------------- ----- -----------..--•----------------------------------------------- •---------- R L FINAL INSP �� -- Date---------------�r- .-2_3.'~(x' - SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press