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LKUrr"-t USE: : . ._. -------- - ---------------- ------- ---- # ---- --------------------------- --- APpI_ICATION FOR SANITATION PERMIT Permit No. ._�Q� - . -- (Complete in Qliplicafe) ---------- ------- - This Permit Ex ires,] Year From Date Issued Date Issued �___� Application is hereby mad to tke'San Joaduin Lo�cal-Health� District for a permit'to construct and install�hwork h�n described. —Th is.�pplication is made in com I*once with Coun`t�r Ordi#ante No. 549. JOB ADDRESS AND L0CATIAYN._ y : , , 1 N-�-------_q-�--------� --------F-OF_ J __ y 9 �i � Owner's NaAle r'+ T_ . . Irv -------- - ru;I ,, ,q a '. ------------- Phone,----------•----' Address__.____._.____. T� 3(� _- � Q ------------------ ---------------------•------------ ------ ...-------- Contracta �VameLE • - a �.`_..�.._ .�,..�_. �. + -•------ - ,. Installation serve: Residence 1 i Phone-------------------------- l ®` Apartmen# blouse i[] (Commercia) ❑ Trailer Court ❑ Motel ❑ Other ❑ Numb er of living units; j__-_ Number of bedrooms _ +- Number of baths ---- Lot sizes.--_x Wathr 5(.""Publics stem Community system�p� i y ❑ y y ❑ PTiyte �ep+h to Water Table 1 _ ft. Character of sotl'to a depth of 3 feet: Sand [a�avel�❑ � Previous Application Made: (If yes,date------------ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan E] 11 --------J No O New Construction: Yes 0—No [] FHA/VA: Yes ET--No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: �! - �(No sep}ic tank or cesspoolp ermPit#edrif ublic-sewer is' available-wi+hin 200 feet.) Septic Tank: Distance from nearest well... ----Distance from foundation---rMate iaf_-_CC}I�JC r Nro. of compartments------ -------4.-------Size-A5X-1--r- x 5 _i Er� ~ Liquid depth Capacity-f,�----P------ Disposal Field: Distance from ne rest wpI) _ _---p g a foundation ndation___.-��--__ Distance to nearest lot line__-�~-•r� Number of lines__ h f Len o eat me --- :---- f R. k r Width of trench-__-_ . -----_-- Type of filter material_ - ,- Depth of filter material-:. -_ ° - f ._-_-- Total length';- Seepage Pit: Distance to nearest well-.__---_-------------Distance from founda.tion_____i___ ..._. � .. -� � ..Distance to neares# lot line___ Lining ma}erial--__ ___ mss— ..eTe _- """� El Number of pits- -- --- --- ----- _ -.. -- Size: Diameter_ Depth----- I ---------------- esspool: Distance from nearest well---------------_Distance from foundation -------------------Lining material--._-_--_ --.--• .-- ❑ ;Size: Diameter----- - --- --------------------De th-.. - ) i tP - ---- --- --- -----------Liquid Capacity------------------ -------gals. Privy: * Distance,fromYnearest well- w•_�- —. -_:1 ?stance from nearest building---------- ------------------------------- Distance to nearest lot line---------- ---------- + -------- -------------------------------------- --------------------------------------- l f � `• Remodeling and/or �epairing (describe):_.'r[R_F_li14 w/ (�T}}------------ y------ PEPT-H------oF - ----------- ; a -- -----' ------------- KO-C-K-------VA-RI-F—S---------- ---------= -------- --------------------- mnP tSA-r -----.-FA1-1%_ �� DAY r14 -�^(- --.�P_�- r � - y -f� Ts Q I he certif I a e prepared this applica.tian.and..thaf.the-work will be done in accordance with San Joaquin County ordina S a r les.,ynd regulations of the San Joaquin Local Health District. C.1 (Sr ) 1 7 ------- i----------------------- ---------------------------"""-"- -------(Owner and/or Contractor ------------------ m -- - ~ Title 9 p --- --------- --- -------- (Plot plan, showing size of lot, location of system In relation to wells, buildin s, eta, ca 6e laced on reverse side): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ +_ __---+___-- _ 1 --------- =----- ----------------------- DATDATE------`�-�--�L 7` REVIEWED BY------ - �------------ � - -- -------�-'��---- -•-•--- ------ --------------- _ t = E- ------:- IJILDING PERMIT lSSkJED--�--------_--- - ------- ---------•------------------- - • - DATE-'I ------- Alterations and/or recommendations:."„:777 ., - -- ___.:._.,,,� �.,_. -7- -----------------------------•----------------------- """ - T-,.,.._.k---------- ---- - ,----------------- --._ m ' ----------------------- - ------------------- ------------------� ' . --- FINAL .(NSP Date........h - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California F.a.c o.