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Top— APPLICATION FOR SANITATION PERMIT Permit No. ..� .. ..f. (Complete in Duplicate) Date Issued 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 described, Thisapplication_is.made in compliance with County Ordinance No. 549. d�_ Lt2'0'02– n.► 1_ JOB ADDRESS AND LOCATION. ( ___ NI'( , r-_--F :�-P1N-------151-NJ_PS-0-N---------- k } .seou�- �1�---�_�.� Owner's Name------ _ - --------------------------- Phone _ _ __-- Address---------------w -------- ------P�-R-K--------------------------------------•---...------------------------------------------------------------------------•------------......- Contractor's Name--------Q-%k)NJEEK- -------- - •-------------------- Phone------------------------------•---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ec. g H v5� �[� Number of living units: ____.___ Number o?bedrooms -____-__ Number of baths _1_____ Lot size ___:-V-_-�____l-Z__.4�___--___-_-__________.__-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes eNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankor cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_Wq�€__Distance from foundation----lQ-_---_Material_.R4FP.WD0b 1 ----------------------- No. of compartments__..__`l--'______-_Size3__X�_K-_�.___Liquid depth_____/--------------Capacity___ pQ Gq L<1 Disposal Field: Distance from nearest well.i QNR—;r___Distance from foundation___ -._.-.-.Distance to nearest lot line..___� __. Number of lines.-__--__-/---------------------Length of each line--------9-�------------Width of french-____~L_ -_____________-_ Type of filter ------Depth of filter material----/9__ ___._Total dength---------3(----------------------- Seepage Pit: Distance to nearest well---_-------------------Distance from foundation--------------------Distance to nearest lot line-------------_--- - ❑ Number of pits----------------------Lining material-.---------------------Size: Diameter-----------------------Depth-------------------------- -_- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----------------------------------t Privy: Distance Df stanDCle fromr nearest well_____________ Depth_._ .._.________.__._Distance from nearest'bui dapgcity._==.___._._----_--_.__---ga ❑ Distance to nearest lot line---------------------- =`-------------------------------------------- --------------------------------------------------------------------- Z Remodeling and/or repairing (describe): / -------- -----•-------- ---------------------------------------------- 1 ------------------------------- ---- -------------------------------------------------------------•----------------------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Owner and/or Contractor Sy:---------------------------------------------------- ----=---------------------------- ---------------------------=--------------(Title)------------------------ --------------- ---- -- -------------- (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 OZ APPLICATION ACCEPTED SY--- FE- -A----------------------------------------------------------------------- DATE--- ------- 5 - 25----- --------------- REVIEWEDBY----------------------___----------------1---------------------------------------------------------------- ------------•- DATE----------------•--------------------- BUILDING PERMIT ISSUED------------------------------------------- -----------= - – DATE- ' Alterations and/or recommendations:----------- - ----------------------------•------------------------------------•-•-----••---------------------------------•-----•-------------- --------------- ---------------------------•--------------- :---------------- ----------------------------------------------------------•-••---------------------------------------•--•------------------------ --- -------------- ----------------------------------- ---------------------------------------------------•--------------------- ----------------------------------- ---------- - --------------- _ -•--------------------------------- : FINAL INSPECTION -- -- -- ------------ ----- -- Date-.---71� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lode, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.