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rUK UH-Ktt u5t: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .�ls�..--.� - ----------------------------- ------- ---------------- (Complete in Duplicate) ---------------- - - This Permit Expires 7 Year From Date Issued Date Issued --- -= Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application.is made in cam lin e with County Ordinance No. 549. tItiJ : 2-f7_ 13 0.-(,S' JOB ADDRESS AND LOCATIO _�1PFr _ �,( - -- R:H -- -------- % '-�-�-4---�c�-.-..-Ct�c��`-H]-----------------•------------ Owner's Name---------- r } :..� ..........Ro5�__.' ----- -. - Phone.---•--------------------------•-- Address �-T�---`-----�---- C ��_. ....... C f xa = - ----------••----------------------------------------- Contractor's Name.OAKJ).$-LE AlC ET �_Pr:=-- YaRD--'-------------------------------------- Phone----------------------_----------- Installation -• -...-•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel LlOther 1:1Number of living units: -1----- Number of bedrooms ;F—.- Number of baths I---- Lot size -----A-CR-Etq - --------------- ; Water Supply: Public system ❑ Community sym E] Private 3Depth to Water Table7 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--------------_----_I No p ew Construction: Yes to ❑ FHA/VA: Yes. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [Naeptic tank or cesspool permitted if public sewer-is-available with'in-200-feet.) Septic k: Distance from nearest well_._-rJ___0----Distan e fro foundation-.16---------Mater-al__601VG.K.�T�--- �.z.___.----Capacity--- Disposal a acit �SO No. of compartments__:-_-�_.----.._.___Size,�X&)X_ Liquid depth--�_- p y------------ - w Disposal Field: Distance from nearest well._ _��___�--.-Distance from foundation.l0----------_- istance to nearest lot line--_5-----_-_-_ i O ®� Number of lines------- r-----------------------Length of each line__-��---, _5___.Width of trench__-,2Y---- ------------------ Seepage --------------- �(J Type of filter material----RQC_,�__Depth of filter material------1.�____t----Total length------------------------- ---.------- See a e Pit: Distance to nearest well Z10_ -__Distance from foundation_- p 9 ,� -- 1V_.-_____.Distance to nearest lot line_ ---�____._- ®� Number of pits__-._.�.-_.-__Lining material__jR_0_C�....Size: Diameter__�X_.V'.___Depth--_�2r-_f Cesspool: Distance from nearest well------------------Distance from foundation------------------- Lining materiaf__._.---_______________ ' ❑ Size: Diameter---- ------------------ --- ------Depth----------------------------------------------------Liquid Capacity- -----------------------..gals. > Privy: Distance from nearest wefl-------------------------------------------------Distance from nearest building--_--------------------------------_--_-- �! ❑ Distance to nearest lot line--.------ - ----------------------------------------- AlRemodeling and/or repairing [describel:-------- VES I-Ks-a--------S-4ND---------�Rjq- L- ------------- �n7T . ---- ------- ----f----------------------------------------------------------------------------------- -------------------- ---------------------- ---------------------------------------------------------------------------------------------••--------------------------------------------------- -- - ------- I hereby y th6flave prep red this application and that the work will be done in accordance with San Joaquin Countyordinances, t laws, rules an regulations of the San Joaquin Local Health District. Signed ----- t. - ` (Signed) ��` --------------------------- - -- -- ----- - ---- ----------------- - -- - caner and/or Contractor) -------- -.- ---------------------------------------- ------------------- 4 .---k _ — - - o or (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY--- .!_L 1_-C�.------------------------ ---------------------------------------- DATE------- I` C - REVIEWED BY------------------ - ---------- -------- '----------------------------- - ------------------------------------------ DATE_ ------------------• --- ----------•--------------------- � BUILDING PERMIT ISSUED.----------------------------------------------- --------------------------------------------------- DATE - ---------------------------------- Alterations and/or recommendations:--------------___.__..._.____-._-.---- __---_ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------- - --- --- ----- -- --------------- FINAL IN TION ----- ---- -- Date------------ /r - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 0. 4