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--—----------- ------------------------------------------------------ -------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. s-1 • ,7 ---------------------- ---------------------------- (Complete in Duplicate) -------------------- ---------- -----------11. 1 - ------- -- This Permit Ex ices I Year From Date Issued Date Issued -��/ 6 Application is'hereby made to the Sari Joaquin Local Healfh District fora perrn�if j 2eidestribed. The'sapplication is m cl o construct and install the work made in com liance"w;th County Ordinance No. 549. A49 NTFC t9 JOB ADDRESS � AND LOCATION_'----til)ln -------------- ------ Owne rl's Name------- - - ------------ ---------- ------ ------- - Phone R77 ---- ------------- --------------- ---- Address---------:.1 - - -----------al __D Contractor's Name........ __1------------------- Inifallafion will serve: Residence ------ -------------- hone.............. ---------- part'Apartment House E] Commercial Ej Trailer Court F] Motel Ej Other 25 SL'1V C-q ii; -----------E---------------------------------- Number of living units: of.bedrooms ---- Number of baAs yo t6, -IvA J---- Lot size ------ Water SUPPIY: Public:system Ef"t6;'M-06nitj system El Private eDepth to Water Table J t. Char'acter of soil to a depth of 3 feet:��Safid 50`�Gravel Sandy Loam E] Clay Loam E] Clay Ej Adobe E3 Hardpan Previous Application Made: (If yes,date--- A-) No UK' New ConsfructiqC Yes 09"INo [_1 FHA/VA: Yes [I No TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic-fank'_or-cesspo' zl� - cesspool 'public is availa6le!wifhin�200-feet..)---L-,�m.-- Septic TankMaterial_ lZ - 1/L1�7 C7 A ., .- t tion r Distance from nearest well 15 -------!�------Distaricpj�om,founcla' EJ N6. of compartments—s -z' ---------------- Liq uid de1p.th___ V Disposal Field: I'L4*04 1 --------- Ca pa city------ Distance from nearest well Ion------ Number of :J _0_r__.Disfanoe to nearest lot -A _/------- -------------Length of ea'�h' _--A f filf-R-Im"ateri 0 _�__.Width of trench.-------;?,Y.l --------- Tyxp6,of filter material--- ------Depth o al-----V-7-11-1-------Total length--- � 0 Seepage Pit: ! I -----------------�;_ --------------- Distance to nearestiw011-----------------------Distance froZoLurida'tion-----------I--------Distance to nearest lot line Eine------_❑ -- ._-...�of pifs---- Lining' ma+8ria; -,P** --Diameter------------ ---------Depth---- ----- Sizd,.- --------------------------- -------------- __-7 Cesspool: Distance from nearest well----------------Distance from lcunclatibn..---------------- Lining material---._..-------__-------- 1771 Size: Diameter-, -----------------v-_�Depth----------- ------------ ----------- ------------ ---- --------Liquid Capacity------------------ ---------gals. Privy: Distance from-ne&-r—esr,;eIJ ----------------Distance from -nearest building----------- ---------------------------- Distance to nearest lot� line.. ------------------------- - ---------------------------------------- Remodeling and/or reIpairing fdescriLe): - ----•------=----------------------- ----------- ------------------ ------- -------------- - ---------------------------------------- ------------ Wa�-----ts-10-- -------JAIsiTm- rtera 1p -------=``-------•----------•-.--------- 41—-------------------- - --------*------------------------------------------------------------------------------------ ---------------------- ---------- i --------------------------- ------------------------------------------------ ---------------------------------------------------------I----------------------------------- I A_J---------------------------- I hers, ce * that I have prepared this apylicati6n and tha � I ---------- ordinances, fa e I "o- , fjhe work will done in accordance with San Joaquin Count s, and rules 'andp'rf-§ulations-of'-fh�e'S��n j�`ai�q`ui_ Co`raI*R-e�a district. r (Signed)---------- ------------- --------------------------I--------I---------------------(Owner and/or Contractor) BY:........ 41 ) ----—-- --------------------*----------------------------------- - --------------�(Tl. 9---------r------------------- e—m in�re-15-tio'-K16-w I . ....... ...... jPlof plan showi_n-g-`sj-ze"of�I8-t- -------------- I; We 66a�+10,-8-f system ------------------------e---------------i----------e c. -can, w p a lg-, buil din§s--f _b ced�on-reverse-side);-- vm RDEPARTMENT USEL ONLY- APPLICATfON.ACCEPTED BY---_.--7-177R.C-7 REVIEWED BY ---------------- -------- ---------------------- DATE..... .""!V---A---- ----V*q4JU VATE--------- --- --------------------------- f-------------------------------- --------- ----------------------------- ---------------------------�* BUILDING PERMIT ISSUED----_-------------------------------------- DATE------ ------------------ ---- ----------- Alfer.�fiops an recommendations: 1 -- -- ------ =A ----------------------------------------------------------------------------------- -------------- - --------------------------------------------------------------- --------- ----------------------------------------------------------------------------------------------- ------------------------------------------ ------------------------------------------------------ --------------------------_--------------- ---- - ------------------ ----- - -- --------------------- ---------------- --------- ------------ ---------------- .......... -- ------ -- ---------------- -- -- ----------------------------- ----------- --------------------------------- ----------- -------------------------- ------ EC FINAL INSP _TIO Date-------- -------------- --- ---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street t Stockton,California Lodi,California Manteca, California Tracy,California E5 9 17EVI6 Ea a-zq am 3.,.3 F.,c[3.