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L- w FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT Permit No. -.f- -------Z- " --------- ------- -------------------------------- / ------------------------'---:--_--;-----------'-_._------ (Complete in Duplicate) Date Issued 7F/ This Permit Expires 1 Year-From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrihetd-�� This application is made in com liarice with County Ordinance No. 549. JOB ADDRESS AND L ATION. P_ k I sF_ _ --'--5OQ- =-----So--------OF------ Owner's Name--n------------ QN-q--- �:H_,A_J>A - '�"' Phone r Address-------------- ST w - X-------5 ----------- - ry} --- - -- '",._'��`w'�, Phone--z."--"-�=------------- Contractor s Name---TD-- _D. T Rf�+��1 p- a : .w.. �. . Installation will serve: Residence @a'Apartment House ❑ mmercial ❑ `Trailer Court ❑ r Motel ❑ 1Other ❑ Number of living units: ---I--- Number of bedrooms 73._ Number of baths /---- Lot size -----------------•------- Water Supply: Public system ❑a Community system El Private Z�/bepth to Water Table .!_ ft. � I Character of soil to a depth of 3-feet: Sand ❑ Gravel ❑ Sandy Loam Ie Clay Loam 2--Clay ❑ Adobe[] Hardpan ❑ Previous Application Made:-(If y s,date ..................) NoET""New Construction: Yes [,r�!1Vo ❑ FHiA/VA: Yes ❑ No�E� TYPE OF INSTALLATION AND-SPECIFICATIONS: =- -^[NoLLseptic'tank-or-cesspool-permitted if public sewer'is available:within 200 feet:] Septic T k: Distance from nearest well____5�P_.- Distance 'from.foundation..... ---------Material_____CIPA.ch.��___._- Ir g1 �f Q:K'57--Liquid de th____.e,/��..�.-r_--Ca acit 1�Q Q---""_ No. of compartments----��-_--'---------Size-------- --- p. f -, P y-- ----- - Disposal Field: Distance from nearest well...,5�----Distance from foundation__ .____-Distance to nearest lot line---- ®� ---- Number of lines-________._!___.____".__.____ __Length of each line____/- .- ��O-Width of french__A_`-----''�._�--�s. i Type of filter material__.RD_C._W,„_Depth of filter material____.- -----Total length--------- ------ r' See istance to neares o nearesto mber of its----""'°- -"-" Ca'_ _." .----Size: Diameter.�_x- ....... r i , I "'" oundation--- Lining material -------------- _ Cesspool: Dzea Diameter:--.nce from nearest well" Depth ce"from f• Liquid Capacity - """"gals. 1 �»� r Priv Distance from nearest well___________________________.___ °""'"r Distance from near*building___ __ .=_-_________________..____... y: ❑ Distance to nearest lot line---------------------- ---------------- --------------- `_A--- .------------------------------ �-p -�.? ----------- ----------- ,` w --- ---------------------------•--------------------- ---Remode4in and/or re airin decibe : - ------------------------------------- ------ ro -------------=-------------------------------- -------------- ------------------------. - --------------------------------- --------- --- ------------------ ----- ------------- � � i -- --------�- -------- ---- ----- •----------------------------------------------- ------------ - ---------------------------------------- -------- I hereby certify that I have prepared this application and that the work-'�wiil.be'Ndone in accordance with San Joaquin County�, ordinances, State laws, and ules and regulations of the,San Joaquin Local Health.District. l� ! s [Signed}__ = ----------------------------------------------------------s------------ ' ' [Ow-ner and/or Contractor) -' - - [TitEeJ — h:. .- 4--------- ----------- --------- -- -_,. [Plot plap, showing size of lot, location of_sysfem in relation to wells, buildings, etc., can be placed on reverse side]. - _ ,. FOR DEPARTMENT USE ONLY BN DATE--------- —7 DATE ----------- APPLICATION ACCEPTED BY..- .- -,--"--------'------ REVIEWEDBY------- ------------------------------------------ --------------------- -------------------------- DATE BUILDINGPERMIT ISSUED------ ------------ -------------------------t--�--------- ----------------- ----- DATE----------------------------- -- � id-------- ' --------- Tf_F.-o-------- Alterations and/or recommendations:____._.__ -ATE--_:.04 Al. _ ---... ------ ' . . . . ; ---------------- ' ' --------------------------' ------ ------------- 9 t ---------- -------------------------------- w --- FINAL INSP N �JQ ------- -- --' Date ' 3Z�. _ cam 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 I � F.FP.G a. •�