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FOR OFFICE USE: --------- ---t---- ------t_--------------------------- 5 Permit No. ,t' .. . �- APPLICATION FOR SANITATION PERMIT ---------------------------- ------------------------- I------------- (Complete in Duplicate) Date Issued ---/,/_,&A ----------- ----------------- ------------------------ -------------- ....... This Permit Expires 1 Year From Date Issued . - - _ - Application. ---- ----- is hereby made to the San Joaquin Local Health Dist rict,for a permit to construct and install the work herein described. This g2l:cl ;L1_:1n co I' nce w' In County Ordinance No. 549. MT c f�- . - 0 . . ..... -------K/ J_ DRE is 9�t LOCAII0N__ Owner's Name-----------G7_ 6:R Q->4---------/ansl��------------------------------ - -------------------------------- -------- Phone------------ --------------- Address-.------- -1?7�--mn...._T--—------B -----247--,----- ------•------------ -11------- --------------------------------------------------------------- --------------- Phone----------------------------------- Contractor's Name--- -------------------------------------------7------------------------------------------------ Installation will serve: Residence JK Apartment House E] -Commercial F] Trailer Court 0 Motel [:] Other E] Number of living units: - Number of bedrooms -5 - Number of baths 7=- Lot size ---j4C.R_F_19.Gr-- ----------------------- Water Supply: Public system F-1 Community system E] Private V.Depth to Wafer Table /2-ft. Character of soil to a depth of 3 feet: Sand k"Gravel Ej Sandy Loam [I Clay Loam 0 Clay C] Adobe E] Hardpan 0 Previous Application Made- (If yes,date---------- _..""-.__.l No R'-__New Construction: Yes E] No ;9,--`FHA/VX Yes C No zl_� TYPE OF INSTALLATION AND SPECIFICATIONS: perm - - sewer'(No septic tank or cesspool er itted if public ;r is available within 200 feet.) Septic >an Distance from nearest well---SO _DistaD,e from foundation-__/Q---------Mat r' al --------- m2- ..Size,5A1X__5 ___L;quid ceph----- Capacify__/6v --- f compartments__ - Disposal Field: Distance from nearest well.,.SO-----Distance from foundation-1-0---------- Distance to nearest lot line___437------ I - - - 6, 1h _36.111 , Number of �ines--------2------------------ ---Length of each line]56 f -Vicith of trench ----------------:i Type of filter mate ri'aI_)3_0_C A----Depth of filter material-___. 4-_/47 -------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------..---.-Distance to nearest lot line___----.-.--"---. ❑ ine----------------- El Number of pits----------------- ----Lining material----------.------------Size: Diameter-----------.--...-. Depth--------------------------------- Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.----------_-_--.----_-----_-----. El Size: Diameter-------------------------- --------.Depth------- --------------------------------------------Liquid Capacity---------------------- -----gals. I Privy: Distance from nearest well------ -----------------------------------------Distance from nearest builcling.- ------------------------------------ F1 Distance to nearest lot line-------------------- -------------------- ------------------------- i Remodeling and/or repairing (describe):-------------- ---------------------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------ ------------I---------------------------------------------- -------------------------------------------------------------------------------------------------------- - ------------ -- ------------------------ -------- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- --------- ----------------------------------------I-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 5d,nedC es, Sf!? )laws, and rules ntl regulations of the San Joaquin Local Health District. f or)-- ----------------------------- -----------(Owner and/or Contractor)---- -- - ---------------------------- ------------------;-----------;-------------[Title).---------------------7--------------- BY:----------------I--------------------------- ------------------------------ (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 DATE----- ------------------ APPLICATION ACCEPTED By__.._7__-,_.R,Q_,-- -------------- --------------------------------------------- REVIEWEDBY------------------------------ -- ------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------- ------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:-------_------------- ---------- -------------------------------------------------------------------------------------------------------------------------- -------- ------------------------------------ -------------------------- --------------------- ------------------------------------------1-------------- ------------------------------------------------------------ -------------------- -------------- ------------------------------------------------------------------------------------------------- -------------- ----------- ---------- --------------------- ------------------------ ------------ --------------- ------------- ... ..... - ----------------------------------------------------------------- - ---------------------- -------- -------------- -------------------- ---- ------------- ------ ------------------- -------------- -- ---------------- - ------- - -------- 2 --------------------- Date...--------- ------------- FINAL INSPE --- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,P-CU.