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, . APPLICATION FOR SANITATION PERMIT Permit No. _11-2-Y---------- '(FC omplete in Duplicate) Date Issued 4`-- S ----- 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 compliance with Count ante No. 549. JOS ADDRESS A%43-1 CATIV111% ------------ ---------- -- ------- Phone Owner's Name------ � - - ---------- --- ------ ------- iT i 41---------`-�-------�---------r- I Address_ ~� ------------------------------------{-------------------------------------------------------------------- ,- T C. __._.�_W - - --------------------------------------------------------- Phone----------------------------------- I Contractor's Name---- ---------------- - ---- ----------- --------- } Installation will serve: Residence Apartment Nouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '�x--��--------- Number of living units: ---I---- Number of bedrooms Z__ Number It of baths _-�__-_ Lot size -- ------ c, Water Supply: Public system & Commuriit-y-system:�.M- Privk ate ❑_. epth to Wafer Table -------- ft. } Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IL Hardpan ❑ It 1>Previous Application Made: Yes ❑ No & New Construction: Yes&- No ElFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' E `, (No septic tank or`cesspool permit}ed'if public sewer is available within 200 feet.) y ( )uncle#ion- "- ------Ma'terial --------------- Septi k: Distance from nearest well_________________Distance from fo Li aid de fh__._____ Y__-.----------Capacity.. � No. of compartments---- -- -------------- Size G4 (p -- Q_ __.Distance to nearest lot dine-------- :' Dispos Distance from nearest well. —__Distance from foundation___ Number of=lines______-'�-�--'1p Le gh offfilter�mlaterial___ +� Width of trench __._03----------------------- - of filter material Zt_ - p --- 1-"Total length-------� 1--------------------------- Type1 _ '{' I ---- L nin mate al-----_--------------".Size::b a e{e _.Distance #o nearest lot line--.-------------- ------- Seepage Pit: Distance of nearest well-;-------------- e ning`, _Didrial from found i i* :_. lame�r--t,,---------- ----------Depth------------------------ Pt '` r-�- o ce from foundation __" '�_ --- Lining material-__---------------------------------- Cesspool: __ ___ _____ _____________ 0 l Cesspool: Distance front nearest well___- f Dista ❑ Size: Diameter.-- . �`-`*• p`:D p ---------------- _=� 'liquid Capacity gals .. ' � ' Distance fr m nearest building ----- ----- ----- --- -- Privy: Distance from; nearest well W1_. y - � � ❑ Distance to nearest lot line T -- ------------- ---•--- - ------------------- ----- ------ ---- 11 - �- ---------------i ---------------�---------------- ----- ---- 1 --R----e--m---o-d-eling and/or repairing (describe]:_____- -___- .-__________ -.- - ----------- ----------------- i---------------•-------- -_---------------- ---- --- " - - r ---------------------------------------------------------- - __ -------------=------------- I herebycertifythat I have re aced this a�licati n and that work will be done in act 9 ' � """""""--- - �ordance with San Joaquin County ordinances, tate las, an ales and re ulat�ons of +he.San Joaquin Lo Health Distric}. { jj l k - _-�- -- ---"_'---• - -- (Owner nd/or Contractor) (Signed)_ f_V-40?> - '-------------------------------------- By --- ---•• ----------- --- - -- --- -------------------------------------------------------------------------(Title) t- = (Plot plan, showing size of lot, location}of system in relation to wells, buildings, etc., can be placed on reverse side). t, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________ __ DATE --- - ---------------------- -- --------- FE ) -------------------------- REVIEWED BY--------------------------------- ----"---- ------f --- --- -- -� - • -------------------------•-------- BUILDINGPERMIT ISSUED---------------------- ---- ------------------------1----------- DATE----------------------------..---------------------•-------- Alte afions and/or recommendations:------ti---- ---------- 31x1 l. -- ------------ -- I -------- -------------------- -- ----------- a1�L 1 rk - ----------------------�--...-------------------------------------------------------- ---------------------- --------------------------- -- -- , -------- ----- ----- ------------------------- - -" FINAL INSPE� ON BY: Date--------1d �1 = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M , Revisea 1.57 F.P.CO.