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FOR OFFICE USESki -------------------------------------------------------- ------ i APPLICATION FOR SANITATION PERMIT Permit No. ---- ---------------- (Complete in Duplicate) Date Issued This Permit Ezires'i Year.From Date Issued " Application is hereby ma e to t e oaquin cal Health District for a permit to construct and install the work herein described. This a viia -on i a i f Ordinance No. 549. ' �}� 1 9p ' IJOB ARESS AND LOCATIO __Si DT # Y-Ef)4 9 f - U� A0_,57v/\(- -RP- Owner's Name-------------�4-J if[ '}----- ...LLSUR--------------- ----------- ------------------- ------• ---------------- Phone------------------------------------ Address__......w�T� /-------3-Q�-----------3-ltr� x �11�11�TECf}- ' F, Contractor's Name-----f-r�XDfiN_... 57F--P-n- ----7-A �---- --------- Phone.. Installation will serve: Residence ffl" Apartment House F] Commercial E] Trailer Court ❑ F]Motel Other E]Number of living units: ..!.-.. Number of bedrooms3---- Number f`baths ;-2-_-. Lot size ---; Z _ ...3246-""""-"""""""""-"-"--"-. Water Supply: Public system ❑ Community system ❑ Private E�Depth to Water Table /0. ft. Character of soil to a depth of 3 feet.! Sand Gravel ❑ Sandy Loarn ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: {If yes,date_---__- ] No New Construction: Yes eNo E] FHA/VA: Yes [� No E] i .TYPE OF INSTALLATION AND SPECIFICATIONS: No,se tic ank.-or cess opi- ermined�if ublic,sew-er is available within,200 feet. Septic,,Tank- Distance from nearest well...-5-.O_.__Distance from foundation-----ILI) M to :al-CoAICRFT_].�__ ____ ________ --- I No. of compartments------2.--------------Size X[-1l_X . __Liquid depth--- ..-.-.Capacity-._ S_OC�__ 1 a�._ .1 f Disposal Field: Mstance from nearest well if Distance from foundatsio�n----/D---------Distance to nearest lot line._.43� -- Number' of lines -_- - .-- - I.. /r �. -. .,_ .......Length of each Iine...C7V.�.�Q..-.Width of trench...._... ._ 6 Type*o'f'filter material..Q K---.Depth of filter material......17-_..___...Total length-----------------I10-_----_.._. Q Seepage Pit: Distance to nearest well_._---------------Distance from foundation--------------------Distance to nearest lot line-.-.._...------._ Number of itro-------------- _Linin material-..____._.-____,__,..Size: Diameter P� g V.-�r}epth-----�--------------------------- � Cesspool: Distance from nearest�welL------ --------Distance from foundation....................Lining 4.1W Size: Diameter------ a�rest.well..-- � Qepth-----------�.-.-....Dis�ance from ... �#apacitY ----------------------------gals. € d Priv Distance.from.ne !� Y- { �'� --- - ------1--------------m nearest building ------------------------------------ -------- --•--------•--------------- ------ O ❑ Distance to.nearest lot line - -- -------- ----- ---- Mr anaw Remodel ing°and/or repairing [descrideJ: -..34 .z_►_+ "�wr'� "" __ - ----""".-- -----"--- ------------ --- -----------------••---- ----- --------- * .. - ---------------------------------------- •----- --- ------ --- �t�-------------- ------------- ------------ ----------------- --------------------------------------------------_- ,------ �-----------------------------------1- -------------------------- y --------! hereby certify t':-.;-;--:---:_-_:------------------------•-------- --------------- ------_---�---------------------------------------------� ----------------- ---------- --- I i have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and iegula 'pops. of the San Joaquin Local Health District. (Signed) ^' 4k� Owner and/or Contractor) ,.: r..$ .- _ _ -.__:.,: —---------- - --- ----- -- - ----- --(Title)----- --- -- i (Plot plan, showing size of iot, location of system In relationfowells, buildings, efc.,{c nbe placed n-re"veerrse side). FOR DEPARTMENT USE ONLY 4L 'i APPLICATION ACCEPTED BY------..7- ............................................................... DATE---------1----1 17�---4/ti, ------------ REVIEWEDBY------------------ ------------ -----1--------------------------------------- -------------------------------------------- DATE---- . -------------------------- ING DTp DATE.------- ----------------------- -------------------------- r = - N -Aiterations and/orrecommndeton . - ...rA --- -------------------:.------------------------="- -------------------- ----------- ------------------------------------------------------------------------------ - ------ ------------ •------------------------------------------------------------------------- -------------- --------------------------- FINAL INSP TI / :... Date '----------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT e 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ti.. F.P.00.