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FOR OFFICE USE: ___________ _________-.___.__..-- ' E �,. APPLICATION FOR SANITATION PERMIT Permit No. __ 23...4.1 ----------------------- ------ -------------------------- ------------------------ ---------- ---- // L.� ------- --------------- ------------------- --- -- (Complete in Duplicate) S �-f �`- i �- - Date Issued ----- --- - ---- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the Son'Joaquin Local Health District Ga permit to construct and install the work herein described. This application is made in co pliance with Cou ty Ordinance o. 549. � = a° Q � � JOB ADDRESS AND LO ATIO�N-- ' -A � / LY - �s7�_i .�?.I -- ------------- Owner's Name----- -------- s [- 1LC�19 ,J e._fhone -- - h Address .T_R�- `-'Z - '-�rL= - .C�L1' - ---------------------------------- Contractor's —---- - 1- --------/ F----------------------- i Installation will serve: ,Residence 13" Apartment.. Commercial ❑ Trailer Court E] Motel ❑ Other ED �01Number'of living units: __�._:!_ .Number of bedrooms _2Number of;baths L______ Lot.size ___/7_ - _________________________ Al ,..�..V. T r Water Supply: Public-system ❑ _Community system...❑ Private .Depth to Water Table 49 ft. Character of soil to a depth og1jeet:, Sand [H Gravel ❑ Sandy Loam 0 Clay Loam p Clay ❑ Adobe ❑ Hardpan gq--- l Previous Application Made: (if yw. ate....................l No Wj-- New,,Con s+ruction: Yes �o ❑ FHA/VA: Yes ❑ No ®� ;. TYPE,OF INSTALLATION AND SPECIFICATIONS: f 4 (No septic --tank or cesspool,permitteif if public sewer is available wi+hin 200 feet.I ' i. Septic Tank: Distance from nearest well °Distance••from-foundation_---_-----:___.Mate ial____.____________..______________________._._. � ,1��` �t�lo: of�compartmen'ts---------�- --Size-t ---Yx� x-' �� ,� Liquid depth•------ Capacity----------------------- Disposal Field "t'.Distance from;nearest"'well �0------Distance fr m foundation____1_0+. .Distance to nearest lot �' -Number of lines______ __ _ Len th,of each line_-_�p �_ Width of trench___._ .' _______..___-.._ }� 7 [ �/ ria �- tr,5 g ; f � b "# -- .I-J�}�17 Type ofjilter.. atena�,RD /K_:___Depfh of filter material______ ._ Total length---------------- --- � -_-- Seepage Pit: Distance to nearest welL. �� ----- Distance from foundation .__.�Q___ ___..Distance to nearest lot line___5.:_.___.. Numb:er of pits-------- _M -Lin g material_ _0---------Size: Diameter X. --------Depth_.__.le __-'-----"" -.. Cesspool: Distance from nearest well________________Distance from foundation....--------_------.Lining material----------- =___. s -` Depth ---------- - ---------.Liquid Capacity----------------------------gals. El Sizer Diameter Privy: Vistance.from nearest well _ ------------------ ,_Distance`fram,nearest building______________ _ __________ --------_ El Distance to nearest.lot line----------------- _ � A�� ---- r- Lr -- -- ------------------- Remodeling and/or Fepairing (de cribe):--: 1)1_Q_�7 I_lv ;_____ _lf._ib_____j lt4f �=__. /_�Q :--.______. -------__5�Smff.M-__-__--_�________-______�,�l .E l-- 0-------L � -------------------------------------'-- ---=-•--------- '----------------------------------------------------------=-------------------••-----------------------------------------------------------7=_RR_O ,- 1 hereby certify that I have prepared this application and thatf_We work will be done in accordance with San Joaquin County ordinances, State laws, and rules,en regulations of the San Joaquin(Loai Health District. 4 _Y w _. -- - rr � IP(SignedOwner �b and/or Contractorf r • -�..-_ -By: . + - -� _. _ -(Title}-� 4G ?_.t�'_�? t,'_:-__...M (Plot plan.,!showing;size of!lo cation of system in reletion to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... � _------------------------------------ DATE------ --?4_r_y-------------- -- - --------------- REVIEWEDBY--------------------------------------------- --- :---- --------------------------------------------------------------------- DATE--------------------•--•------------------------------------ BUILDING'PERMIT-ISSUED_...........i"-----= � `m.�,':�._-= � "` - T- =---------- " ".�DA-TE=" ",� = '= ==----=---"--_--------------- Alterations and/or recammendattons: ---------------------------------------------------------------------- j W. ,�iita�+1 1 L --- -------•------------------------------------------------------•----- •------------------------------------- - -•-------------------------------•- -•---•---------------- ----------------------------- - ----------------- - FINAL INSPECTI Y - - ---------- - -------------------- ' m.� SAN JOAQUIN LOCAL HEALTH DISTRICT j 1501 F.hlaielton Ave. + 300 West Oak Street 124 Sycamore Street 205 West 9th Street idi,California Manteca,California Trac California ,. Stockton,Californiaf: lifi _ Y. ES 9 REVESEO 8-59 3M 3-'63 P.P-CC.